The following abstract, Poster Number 102A in the Cardiovascular Pathology Poster Presentations, was inadvertently omitted from the December 1999 Supplement to Critical Care Medicine.
CORONARY CALCIFICATION SCORE AS DETERMINED BY ELECTRON BEAM COMPUTED TOMOGRAPHY (EBCT) PREDICTS POSTOPERATIVE MYOCARDIAL MORBIDITY AND MORTALITY IN A NONCARDIAC SURGERY POPULATION
Lucy Wibbenmeyer, Robert Weiss, Brad Thompson, Margery Amelon, G. Patrick Kealey, Bonnie Robinson, William Stanford, Univ of Iowa Hosp & Clinics, Iowa City, IA
Introduction: Electron beam computed tomography (EBCT) coronary calcification score (CCS) has been found to be a strong predictor of future cardiac events. The role of CCS in perioperative risk stratification has not been determined. Methods: Twenty-one patients at high or moderate risk for cardiac disease undergoing noncardiac surgery were prospectively evaluated. Mean age was 68 ± 10 yrs (53-86). Male to female ratio was 13/9. There were 19 high-risk patients (documented CAD or planned vascular surgery), and 2 moderate-risk patients (two or more of the following: age >65, HTN, current smoker, DM, hyperlipidemia, or prior vascular surgery). CCS was determined by EBCT using the method of Agatson. Forty 3-mm contiguous slices were evaluated using a threshold of 130 Hounsfield units, and a 3 pixel minimum. Results: Four patients had enzymatic evidence of a perioperative MI [mean cardiac troponin I (cTnI) level, 6.9 ± 4.1 ng/ml; range, 3-10.4]. One of them sustained a cardiac death. For the entire population mean CCS was 1811 ± 2279 (range, 0.0-9724). Perioperative MI occurred in 4 of 8 patients with a CCS > 1900 vs. none of 13 patients with CCS <1900 (p = .0046). Neither clinical history of preoperative cardiac disease (n = 19) nor positive noninvasive cardiac evaluation (n = 6) accurately predicted perioperative MI (p > .05). Conclusions: In this preliminary prospective study of high-risk cardiac patients, the CCS as determined by EBCT shows utility in identifying a population at risk for perioperative cardiac events. Further evaluation of the prognostic ability of EBCT in predicting perioperative cardiac events warrants continued study.