Caldonazo Tulio, Kirov Hristo, Dochev Ivan, Fischer Johannes, Runkel Angelique, Dewey Marc, Cardoso Rhanderson, Teichgräber Ulf, Mukharyamov Murat, Gräger Stephanie, Doenst Torsten
Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany.
Department of Radiology, Charité University Hospital, Berlin, Germany.
Am J Cardiol. 2025 Feb 15;237:1-5. doi: 10.1016/j.amjcard.2024.11.015. Epub 2024 Nov 23.
Coronary computed tomography angiography (CCTA) has emerged as a noninvasive alternative to invasive coronary angiography (ICA) for diagnosing coronary artery disease (CAD). Hence, the question of CCTA's ability to guide surgical decision-making moves into the center of attention. CCTA is specifically powerful in ruling out CAD. We, therefore, performed a meta-analysis and systematic review to compare the clinical end points between patients who received ICA or CCTA to rule out CAD before valve surgery. A total of 3 databases were assessed. The primary outcome was perioperative mortality. Secondary outcomes were acute kidney injury (AKI), myocardial infarction (MI), stroke, and major adverse cardiovascular events (MACEs). The odds ratio (OR) and the respective confidence interval (CI) was calculated. A random-effects model was performed. A total of 5 studies with 6,654 patients qualified for the analysis. There was no significant difference between the 2 groups regarding the primary end point (OR 1.20, 95% CI 0.67 to 2.15, p = 0.53). The secondary outcomes also did not show any significant differences in AKI (OR 1.14, 95% CI 1.14, 0.88 to 1.49, p = 0.32), MI (OR 0.89, 95% CI 0.65 to 1.22, p = 0.45), stroke (OR 1.12, 95% CI 0.48 to 2.60, p = 0.79), or MACEs (OR 1.17, 95% CI 0.86 to 1.59, p = 0.33) incidences. The analysis suggests that CCTA is a safe and reliable noninvasive alternative to ICA for coronary imaging before valve surgery. Conceivable differences in imaging modalities were not associated with increases in perioperative mortality, AKI, MI, stroke, or MACEs.
冠状动脉计算机断层扫描血管造影（CCTA）已成为一种用于诊断冠状动脉疾病（CAD）的非侵入性替代侵入性冠状动脉造影（ICA）的方法。因此，CCTA指导手术决策的能力问题成为关注的焦点。CCTA在排除CAD方面特别有效。因此，我们进行了一项荟萃分析和系统评价，以比较在瓣膜手术前接受ICA或CCTA以排除CAD的患者之间的临床终点。共评估了3个数据库。主要结局是围手术期死亡率。次要结局是急性肾损伤（AKI）、心肌梗死（MI）、中风和主要不良心血管事件（MACE）。计算了比值比（OR）和各自的置信区间（CI）。采用随机效应模型。共有5项研究、6654例患者符合分析条件。两组在主要终点方面无显著差异（OR 1.20，95%CI 0.67至2.15，p = 0.53）。次要结局在AKI（OR 1.14，95%CI 0.88至1.49，p = 0.32）、MI（OR 0.89，95%CI 0.65至1.22，p = 0.45）、中风（OR 1.12，95%CI 0.48至2.60，p = 0.79）或MACE（OR 1.17，95%CI 0.86至1.59，p = 0.33）发生率方面也未显示出任何显著差异。分析表明，CCTA是瓣膜手术前用于冠状动脉成像的一种安全可靠的非侵入性替代ICA的方法。成像方式上可想象的差异与围手术期死亡率、AKI、MI、中风或MACE的增加无关。
