CCTA Proven Safe for Preoperative CAD Assessment in Valve Surgery — Meta-Analysis Confirms Noninvasive Alternative to ICA

A new systematic review and meta-analysis published in The American Journal of Cardiology (doi: 10.1016/j.amjcard.2024.11.015) compared coronary computed tomography angiography (CCTA) with invasive coronary angiography (ICA) as preoperative imaging strategies to rule out coronary artery disease (CAD) prior to valve surgery.

Across five observational studies involving 6,654 patients, no significant differences were found between CCTA and ICA in terms of key perioperative risks:

  • Perioperative mortality: OR 1.20 (95% CI 0.67–2.15; p = 0.53)
  • Acute kidney injury (AKI): OR 1.14 (95% CI 0.88–1.49; p = 0.32)
  • Myocardial infarction: 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)
  • Major adverse cardiovascular events (MACEs): OR 1.17 (95% CI 0.86–1.59; p = 0.33)

Clinical takeaway:
CCTA is a safe and reliable noninvasive alternative to ICA for preoperative CAD assessment before valve procedures. With high specificity for excluding CAD and the added benefit of visualizing extracoronary thoracic structures, CCTA supports modern, patient-friendly risk stratification—without increased perioperative complication rates.

Read the full open access article here: https://doi.org/10.1016/j.amjcard.2024.11.015