Abstract 18142: Head-to-Head Comparison of the Prognostic Accuracy of Computed Tomography Coronary Angiography and Dobutamine Stress Echocardiography in Patient Undergoing Noncardiac Surgery
Objectives: The aim of the study was to compare the prognostic accuracy of dobutamine stress echocardiography (DSE) and computed tomography coronary angiography (CTA) in patients with undergoing intermediate to high risk noncardiac surgery.
Methods: Between July 2014 and April 2016, 220 patients with more than one clinical risk factor for perioperative cardiovascular events were enrolled prospectively. After exclusions, 208 patients performed both DSE and CTA before intermediate to high risk noncardiac surgery. The estimating perioperative clinical risk was classified according to revised cardiac risk index (RCRI), DSE results were categorized as abnormal response (inducible ischemia, nonviable infarction, or drop in systolic BP ≥20 mmHg during test) or not, and CTA results were assessed using the severity of stenosis (significant stenosis: ≥50% maximal stenosis). Perioperative cardiovascular events were defined as cardiac death, non-fatal myocardial infarction, myocardial injury after noncardiac surgery, pulmonary edema, fatal arrhythmias, and prophylactic revascularization.
Results: Twenty-six patients (12%) had perioperative cardiac events. RCRI-adjusted regression analyses showed that both abnormal response on DSE, (hazard ratio [HR]: 5.7, 95% confidence interval [CI]: 2.29 to 14.25; p <0.001) and presence of significant stenosis (HR: 18.8, 95% CI: 5.27 to 67.42; p <0.001) on CTA were independently predictive of perioperative cardiovascular events. When comparing ROC curves of the combination models, although both DSE (C-statistic: 0.787) and CTA (C-statistic: 0.891) improved risk stratification beyond clinical risk factors (C-statistic: 0.719), DSE in addition to CTA (C-statistic: 0.918) did not provide better discrimination than CTA alone.
Conclusions: In the perioperative risk stratification of patients who were undergoing intermediate to high risk noncardiac surgeries, CTA may have a higher prognostic value compared with DSE.
Author Disclosures: J. Ahn: None. Y. Jeong: None. J. Jang: None. J. Koh: None. M. Kang: None. J. Hwang: None. J. Park: None.
- © 2016 by American Heart Association, Inc.