冠状动脉CT血管造影判断冠状动脉粥样硬化对非心脏手术计划的影响及术前风险评估的价值

Influence of coronary computed tomography angiography for estimating coronary atherosclerosis on non-cardiac surgical plan and its value to preoperative risk assessment

目的探讨冠状动脉CT血管造影判断冠状动脉粥样硬化对非心脏手术计划的影响及术前风险评估的价值。方法回顾性分析2022年11月至2023年5月于解放军总医院第四医学中心拟行非心脏手术,术前怀疑或确诊冠状动脉粥样硬化性心脏病的患者187例,年龄39~81岁,平均年龄(64.4±8.7)岁,其中男性70例,女性117例。冠状动脉CT血管成像(CCTA)评价冠状动脉粥样硬化管腔狭窄情况、分析推迟或放弃手术的原因、心脏CTA结果对手术计划的影响、判断冠状动脉管腔受累程度及受累血管与心血管事件的相关性。结果经冠状动脉CTA后,选择推迟或放弃手术共34例患者,其中放弃手术19例、推迟手术15例,如期手术153例(81.8%);如期手术组较推迟或放弃手术组左心室射血分数高,且差异有统计学意义;三支血管病变与无狭窄相比,经过Fisher精确检验,二者差异有统计学意义(P<0.05);冠状动脉狭窄严重程度与非心脏手术计划的改变有关(P<0.05),且是非心脏手术计划改变的危险因素。结论非心脏手术前怀疑或确诊冠状动脉粥样硬化性心脏病(冠心病)患者,冠状动脉CTA结果明显影响手术计划,冠状动脉狭窄严重程度是非心脏手术计划改变的危险因素。

Objective To investigate the influence of coronary computed tomography angiography(CCTA)for estimating coronary atherosclerosis on non-cardiac surgical plan and its value to preoperative risk assessment.Methods The patients(n=187,aged 39-81,average age=64.4±8.7,including 70 males and 117 females)with suspected or confirmed coronary heart disease(CHD)and planned to receive non-cardiac surgical were retrospectively analyzed in the Fourth Medical Center of Chinese PLA General Hospital from Nov.2022 to May 2023.The lumen stenosis of CHD was reviewed by using CCTA,the reasons for delaying or abandoning surgery and influence of CCTA on surgery plan were analyzed,and involved degree of coronary lumen and correlation between involved vessels and cardiovascular events were reviewed.Results After CCTA,the surgery was delayed or abandoned in 34 cases(18.2%)including abandoned surgery in 19 cases(abandoned group)and delayed surgery in 15 cases(delayed group).There were 153 patients(81.8%)had surgery on schedule(scheduled group).The level of left ventricular ejection fraction(LVEF)was higher in scheduled group than that in delayed group and abandoned group with statistical significance.The results of Fisher exact test showed that the difference between 3-vessel lesions and non-stenosis had statistical significance(P<0.05).The severity of coronary artery stenosis was correlated to changes in non-cardiac surgery plan(P<0.05),and it was a risk factor for changes in non-cardiac surgery plan.Conclusion The results of CCTA can significantly affect non-cardiac surgery plan in patients with suspected or confirmed CHD before the surgery,and severity of coronary artery stenosis is a risk factor of changes in non-cardiac surgery plan.