Ren Xinshuang, Liu Kun, Zhang Heng, Meng Ying, Li Haojie, Sun Xiaogang, Sun Hansong, Song Yunhu, Wang Liqing, Wang Wei, Wang Chuangshi, Wang Yang, Hou Zhihui, Gao Yang, Yin Weihua, Zheng Zhe, Lu Bin
Department of Radiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.
Department of Surgery Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.
J Am Heart Assoc. 2021 Aug 3;10(15):e019531. doi: 10.1161/JAHA.120.019531. Epub 2021 Jul 29.
Background Coronary computed tomography angiography (CCTA) is a noninvasive, less expensive, low-radiation alternative to invasive coronary angiography (ICA). ICA is recommended for coronary evaluation before heart valvular surgery, and the supporting evidence for CCTA is insufficient. Our study is a single-center, prospective cohort study designed to evaluate the feasibility of CCTA instead of ICA in detection of coronary artery disease before surgery. Methods and Results Heart valvular surgery candidates were consecutively enrolled between April 2017 and December 2018. Nine hundred fifty-eight patients in the CCTA group underwent CCTA primarily, and those with ≥50% coronary stenosis or uncertain diagnosis underwent subsequent ICA. One thousand five hundred twenty-five patients in the ICA group underwent ICA directly before surgery. Coronary artery bypass grafting decision was made by surgeons according to CCTA or ICA results. Most of the patients (78.8%) in the CCTA group avoided invasive angiography. Thirty-day mortality (0.7% versus 0.9%, =0.821), myocardial infarction (6.4% versus 6.9%, =0.680 ), and low cardiac output syndrome (4.2% versus 2.8%, =0.085) were similar in the CCTA and ICA groups. Median duration of follow-up was 19.3 months (interquartile range, 14.2-30.0 months), cumulative rates of mortality (2.6% versus 2.6%, =0.882) and major adverse cardiac events (9.6% versus 9.0%, =0.607) showed no difference between the 2 groups. Coronary evaluation expense was lower in the CCTA group ($149.6 versus $636.0, <0.001). Conclusions The strategy of using CCTA as a doorkeeper in coronary evaluation before heart valvular surgery showed noninferiority in identification of candidates for coronary artery bypass grafting and postoperative safety.
背景 冠状动脉计算机断层扫描血管造影（CCTA）是一种侵入性冠状动脉造影（ICA）的非侵入性、成本较低、辐射量小的替代方法。ICA被推荐用于心脏瓣膜手术前的冠状动脉评估，而CCTA的支持证据不足。我们的研究是一项单中心前瞻性队列研究，旨在评估CCTA而非ICA在术前检测冠状动脉疾病中的可行性。方法和结果 2017年4月至2018年12月期间连续纳入心脏瓣膜手术候选者。CCTA组的958例患者主要接受CCTA检查，冠状动脉狭窄≥50%或诊断不确定的患者随后接受ICA检查。ICA组的1525例患者在手术前直接接受ICA检查。冠状动脉搭桥手术的决策由外科医生根据CCTA或ICA结果做出。CCTA组的大多数患者（78.8%）避免了侵入性血管造影。CCTA组和ICA组的30天死亡率（0.7%对0.9%，P = 0.821）、心肌梗死（6.4%对6.9%，P = 0.680）和低心排血量综合征（4.2%对2.8%，P = 0.085）相似。中位随访时间为19.3个月（四分位间距，14.2 - 30.0个月），两组的累积死亡率（2.6%对2.6%，P = 0.882）和主要不良心脏事件（9.6%对9.0%，P = 0.607）无差异。CCTA组的冠状动脉评估费用较低（149.6美元对636.0美元，P < 0.001）。结论 在心脏瓣膜手术前将CCTA用作冠状动脉评估的守门策略在识别冠状动脉搭桥手术候选者和术后安全性方面显示出非劣效性。
