CCTA and CACS for preoperative cardiovascular risk stratification in patients undergoing noncardiac surgery: A systematic review and meta-analysis.

BACKGROUND

Major Adverse Cardiovascular Events (MACE) is a common cause of perioperative and long-term morbidity and mortality following noncardiac surgery. Patients who require preoperative cardiovascular risk stratification, traditionally undergo noninvasive cardiac imaging using myocardial perfusion imaging or stress echocardiography. Coronary Computed Tomography Angiography (CCTA) and Coronary Artery Calcium Score (CACS) have demonstrated prognostic value in predicting postoperative MACE and effectively risk stratifying patients undergoing noncardiac surgery.

METHODS

We performed a systematic search in MEDLINE and Scopus for studies reporting data on preoperative CCTA and CACS results and postoperative short- and long-term MACE in patients undergoing noncardiac surgery. A random-effect model (DerSimonian-Laird approach) was used to estimate the pooled Odds Ratios for MACE according to different CCTA and CACS results. A bivariate random-effects meta-analysis model was employed to assess pooled sensitivity and specificity of CCTA and CACS for MACE, and meta-analyses of proportions were performed to assess pooled positive predictive value (PPV), negative predictive value (NPV), and accuracy estimates.

RESULTS

Out of 1,009 studies identified from the literature search, fourteen studies were included in the meta-analysis. Obstructive stenosis (stenosis ≥50 ​%) on CCTA demonstrated increased odds for MACE compared to nonobstructive stenosis or normal findings, both in short- and long-term postoperative period (OR: 3.94, 95 ​% CI: 1.63-9.54 and OR: 8.95, 95 ​% CI: 4.48-17.87, respectively). Similar outcomes were observed when comparing patients with severe CACS (CACS ≥400) (OR: 2.29, 95 ​% CI: 1.35-3.86 and OR: 5.45, 95 ​% CI: 3.49-8.51 for short- and long-term postoperative MACE, respectively). In terms of prognostic performance CCTA and CACS demonstrated high NPV but moderate PPV for short- and long-term postoperative MACE.

CONCLUSION

Obstructive stenosis on CCTA as well as severe CACS (CACS ≥400) can reliably risk stratify patients undergoing noncardiac surgery.

PROTOCOL REGISTRATION: CRD42024600216.