• Jong-Hwa Ahn, Young-Hoon Jeong, Yongwhi Park, Choong Hwan Kwak, Jeong Yoon Jang, Jin-Yong Hwang, Seok-Jae Hwang, Jin-Sin Koh, Kye-Hwan Kim, Min Gyu Kang, and Jeong Rang Park.
• Division of Cardiology, Department of Internal Medicine, Gyeongsang National University, School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea.
• J Cardiovasc Comput Tomogr. 2020 Nov 1; 14 (6): 471-477.

BackgroundDobutamine stress echocardiography (DSE) and coronary computed tomography angiography (CTA) can provide perioperative prognostic information in risk stratification of patients undergoing noncardiac surgery. This study directly compared the prognostic value of DSE and CTA in patients undergoing noncardiac surgery.MethodsBetween 2014 and 2016, 215 patients with more than one clinical risk factor for perioperative cardiovascular (CV) events were enrolled prospectively. They received both DSE and CTA before noncardiac surgery. Perioperative clinical risk was classified according to the revised cardiac risk index (RCRI), DSE results were categorized as abnormal (inducible ischemia and/or nonviable infarction) or not. CTA results were assessed using the severity of stenosis, with significant stenosis being ≥50% of the luminal diameter). After the exclusion, a total of 206 patients remained. Perioperative CV events were defined as CV death, non-fatal myocardial infarction (MI), myocardial injury, pulmonary edema, non-fatal stroke, and systemic embolism within 30 days after surgery.ResultsTwenty-four patients (12%) had perioperative cardiac events (1 cardiac death, 10 non-fatal MI, 8 myocardial injury, 11 pulmonary edema, 1 non-fatal stroke, and 1 pulmonary embolism). Following adjustment for baseline RCRI score, abnormal result on DSE (OR, 6.08, 95% CI, 2.41 to 15.31, P < 0.001), significant CAD on CTA (OR, 18.79; 95% CI, 5.24 to 67.42, P < 0.001), and high CACS (OR, 4.19; 95% CI, 1.39 to 12.60, P = 0.011) remained significant predictors of perioperative CV events.ConclusionsDSE and CTA are independent predictive factors of events in patients undergoing noncardiac surgery. Among them, assessment of significant CAD using CTA might show a higher prognostic value compared with DSE before noncardiac surgery.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT02250963.Copyright © 2020 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

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