Computed Tomography and Scintigraphy vs. Cardiac Catheterization for Coronary Disease Screening Prior to Noncardiac Surgery

摘要

Objective: The goal of this study was to investigate the utility of multidetector-row computed tomography (MDCT) and adenosine triphosphate stress cardiac single photon emission computed tomography (ATP-SPECT) in evaluating coronary artery disease (CAD) in patients scheduled for non-cardiac surgery.Methods: We routinely performed preoperative echocardiography and exercise stress electrocardiography to screen patients scheduled for non-cardiac surgery. Of 848 consecutive preoperative patients (Group A), 49 patients with screening examination abnormalities had MDCT and ATP-SPECT. Of 809 consecutive preoperative patients studied at an earlier time (Group B), 58 patients with screening examination abnormalities had cardiac catheterization in addition.Results: The number of patients in Groups A vs. B having additional screening examinations was comparable, with no significant difference in perioperative cardiac events. Based on results of the additional tests in the two Groups, percutaneous coronary intervention (PCI) or coronary bypass grafting (CABG) for CAD was carried out in 2 Group A (1 PCI and 1 CABG) and 7 Group B (5 PCI and 2 CABG) patients, again with no significant differences between the groups. However, total medical expenses in patients having additional cardiac examinations were significantly reduced in Group A vs. Group B (140,030±34,800 vs. 187,170±26,120 yen, respectively, p=0.0002).Conclusion: Non-invasive examination prior to noncardiac surgery using MDCT and ATP-SPECT in patients suspected of having CAD appears to be a useful screening procedure. Compared with invasive cardiac catheterization, CT testing has comparable diagnostic utility without an increase in perioperative cardiac events, and in addition has an improved cost-benefit profile.