Abstract 2625: Preoperative Computed Tomography Coronary Angiography to detect Significant Coronary Artery Stenosis in Patients referred for Valve Surgery
Conventional coronary angiography (CCA) is recommended in patients scheduled for valve surgery. The diagnostic performance of the 64-slice Computed Tomography scanner to rule out or detect significant coronary lesions in this clinical relevant patient population is unknown. During a 6-month period, 145 patients were prospectively identified from a consecutive patient population scheduled for valve surgery. After CCA patients were asked to undergo CT coronary angiography (CTCA). 48 patients were excluded: atrial fibrillation (n:26), impaired renal function (n=5), previous allergic reaction to contrast (n= 4), hospitalization in peripheral hospital (n=4), no CCA (n=4), previous coronary bypass surgery (n=1) and percutaneous coronary intervention (n=4). Of the remaining 97 patients 27 denied informed consent. Thus, the study population comprised 70 patients (49 male, 21 female; mean age 63 ± 11 years. Aortic valve stenosis was seen in 31 patients, mitralic valve insufficiency in 25 and other valve pathology in 8. Six patients had redo valve surgery. Prevalence of significant lesions per patient was 25,7 %. Mean scan-time was 12.8± 1.3 seconds. 71% of patients received β-blockers and 64 % lorazepam resulting in a mean heart rate of 59.5±7.5 b.p.m. All patients with a significant lesion were detected. Sensitivity, specificity, positive and negative predictive value of CTCA for the detection of significant stenoses on a per-patient, per-vessel and per-segment basis is depicted in the attached table⇓. The diagnostic accuracy of 64 slice CTCA for ruling out the presence of significant coronary lesions in patients undergoing valve surgery is excellent and allows CTCA implementation as a gatekeeper in these patients.