Invasive Coronary Angiography Versus Noninvasive Computed Tomography Coronary Angiography as Preoperative Coronary Imaging for Valve Surgery

Abstract

Coronary computed tomography angiography (CCTA) has emerged as a noninvasive 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 the clinical end points between patients who received ICA or CCTA to rule out CAD before valve surgery. A total of 3 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 (MACEs). The odds ratio (OR) and the respective confidence interval (CI) was calculated. A random-effects model was performed. A total of 5 studies with 6,654 patients qualified for the analysis. There was no significant difference between the 2 groups regarding the primary end point (OR 1.20, 95% CI 0.67 to 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 to 1.49, p = 0.32), MI (OR 0.89, 95% CI 0.65 to 1.22, p = 0.45), stroke (OR 1.12, 95% CI 0.48 to 2.60, p = 0.79), or MACEs (OR 1.17, 95% CI 0.86 to 1.59, p = 0.33) incidences. The analysis suggests that CCTA is a safe and reliable noninvasive 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 MACEs.

Keywords: computed tomography; coronary artery disease; invasive coronary angiography; valve surgery.