CT Angiography Prior to Cardiac Valve Surgery
What is the accuracy of coronary computed tomography angiography (CCTA) in patients prior to valve surgery?
This meta-analysis examined patients with both CCTA and invasive coronary angiography prior to valve surgery, and evaluated the diagnostic accuracy of CCTA to identify obstructive coronary artery disease (CAD) (stenosis ≥50%) as compared to invasive coronary angiography.
This meta-analysis included 1,107 patients from 17 studies. The prevalence of obstructive CAD was 28%. The pooled sensitivity and specificity were 93% (95% confidence interval [CI], 86-97%) and 89% (95% CI, 86-91%), respectively. CCTA in patients with versus without aortic stenosis had similar sensitivity (93%; 95% CI, 85-97%; vs. 94%, 95% CI, 60-99%), while patients with versus without aortic stenosis had lower specificity (87%; 95% CI, 84-90; vs. 96%, 95% CI, 89-98%).
CCTA has high sensitivity and specificity to identify obstructive CAD in patients planned for valve surgery. In patients with aortic stenosis, the specificity of CCTA may be reduced.
This study demonstrates that CCTA has high accuracy to identify obstructive CAD (defined as a stenosis ≥50%) in patients planned for valve surgery. Patients with aortic stenosis had a higher rate of false-positive studies, which may be expected as these patients may have increased coronary calcification, which can result in calcification ‘blooming’ and overestimation of lesion stenoses. It is important to note that some of the studies excluded noninterpretable segments from the analyses, which can bias the results. Further, the meta-analysis does not explicitly state how many patients had prior coronary revascularization, and it should be noted that CCTA has marked limitations in assessing stent patency. Overall, the study supports a potential role in CCTA prior to vascular surgery in patients considered to be at low or intermediate risk of CAD.
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