Invasive Coronary Angiography versus Non-invasive CT Coronary Angiography as Preoperative Coronary Imaging for Valve Surgery.

Abstract

Objective: Coronary computed tomography angiography (CCTA) has emerged as a non-invasive alternative to invasive coronary angiography (ICA) for diagnosing coronary artery disease (CAD). Hence, the question of CCTA's ability to guide surgical decision-making moves into the center of attention. CCTA is specifically powerful in ruling out CAD. We therefore performed a meta-analysis and systematic review to compare clinical endpoints between patients who received ICA or CCTA to rule out CAD before valve surgery.

Methods: Three databases were assessed. The primary outcome was perioperative mortality. Secondary outcomes were acute kidney injury (AKI), myocardial infarction (MI), stroke and major adverse cardiovascular events (MACE). Odds ratio (OR) and the respective confidence interval (CI) was calculated. Random effects model was performed.

Results: A total of 5 studies with 6,654 patients qualified for the analysis. There was no significant difference between the two groups regarding the primary endpoint (OR= 1.20, 95% CI, 0.67-2.15, p= 0.53). The secondary outcomes also did not show any significant differences in AKI (OR= 1.14, 95% CI, 1.14, 0.88-1.49, p=0.32), MI (OR= 0.89, 95% CI, 0.65-1.22, p= 0.45), stroke (OR= 1.12, 95% CI, 0.48-2.60, p= 0.79) or MACE (OR= 1.17, 95% CI, 0.86-1.59, p= 0.33) incidences.

Conclusions: The analysis suggest that CCTA is a safe and reliable non-invasive alternative to ICA for coronary imaging before valve surgery. Conceivable differences in imaging modalities were not associated with increases in perioperative mortality, AKI, MI, stroke or MACE.