Head-to-head comparison of prognostic accuracy in patients undergoing noncardiac surgery of dobutamine stress echocardiography versus computed tomography coronary angiography (PANDA trial): A prospective observational study

被引：5

作者：

Ahn, Jong-Hwa ^{[1
,2
]}

Jeong, Young-Hoon ^{[1
,2
]}

Park, Yongwhi ^{[1
,2
]}

Kwak, Choong Hwan ^{[1
,2
]}

Jang, Jeong Yoon ^{[1
,2
]}

Hwang, Jin-Yong ^{[3
,4
]}

Hwang, Seok-Jae ^{[3
,4
]}

Koh, Jin-Sin ^{[3
,4
]}

Kim, Kye-Hwan ^{[3
,4
]}

Kang, Min Gyu ^{[3
,4
]}

Park, Jeong Rang ^{[3
,4
]}

机构：

[1] Gyeongsang Natl Univ, Sch Med, Div Cardiol, Dept Internal Med, Chang Won, South Korea

[2] Gyeongsang Natl Univ, Changwon Hosp, Chang Won, South Korea

[3] Gyeongsang Natl Univ, Sch Med, Div Cardiol, Dept Internal Med, Jinju, South Korea

[4] Gyeongsang Natl Univ Hosp, Jinju, South Korea

来源：

JOURNAL OF CARDIOVASCULAR COMPUTED TOMOGRAPHY | 2020年 / 14卷 / 06期

关键词：

Dobutamine stress echocardiography; Coronary computed tomographic angiography; Risk stratification before noncardiac surgery; ARTERY-DISEASE; CARDIAC RISK; CT ANGIOGRAPHY; EVENTS; PREDICTION; MORTALITY; OUTCOMES;

D O I：

10.1016/j.jcct.2020.02.001

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Dobutamine 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. Methods: Between 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. Results: Twenty-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. Conclusions: DSE 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.

引用

页码：471 / 477

页数：7

共 31 条

[1] Risk Stratification Using Computed Tomography Coronary Angiography in Patients Undergoing Intermediate-Risk Noncardiac Surgery [J].