Association between preoperative coronary computed tomography angiography-derived parameters and myocardial injury after non-cardiac surgery
Q Zhang, F Fan, Z Zhou, W Hou, Z Xu, X Liang, B Zheng, Y GongAbstract
Background
Myocardial injury after non-cardiac surgery (MINS) often lacks typical ischemic symptoms and ECG changes, leading to misdiagnosis despite its link to adverse prognosis. Preoperative non-invasive coronary function assessment remains underexplored. This study utilized coronary computed tomography angiography (CCTA)-derived parameters, including computed tomography–derived fractional flow reserve (CT-FFR), peri-coronary fat attenuation index (PFAI), transluminal attenuation gradient (TAG), and coronary artery calcium score (CACS).
Objective
To investigate the correlation and incremental predictive value of preoperative CCTA-derived parameters for MINS.
Methods
This single-center retrospective study included consecutive patients who underwent non-cardiac surgery (Jan 2013–July 2022) with CCTA performed within six months preoperatively. We excluded patients with missing troponin, emergency surgeries, prior CABG, post-CCTA PCI, poor image quality, specific non-ischemic MINS causes, or elevated preoperative troponin (>99th percentile upper reference limit (99% URL)). The primary outcome was MINS (postoperative cardiac troponin I >99% URL within 3 days). K-means clustering categorized patients based on five CCTA indicators. Stepwise regression determined covariates for a reference model. Incremental value over the Revised Cardiac Risk Index (RCRI) and the reference model was assessed via area under the curve (AUC), likelihood ratio tests, and net reclassification improvement (NRI).
Results
Among 702 included patients (median age 69.0 years, 46.3% women), 115 (16.4%) developed MINS. K-means clustering identified two groups; Cluster 2 (better overall coronary function) exhibited a lower risk than Cluster 1 (OR=0.54, 95% CI 0.34–0.87) after adjusting for clinical and perioperative factors. Specifically, CT-FFR showed a stable correlation with MINS: for every 0.1 increase, risk decreased (OR=0.79, 95% CI 0.64–0.99). Using a 0.75 threshold, the CT-FFR ≥0.75 group had significantly lower risk (OR=0.49, 95% CI 0.28–0.86). High TAG (>median) also indicated lower risk (OR=0.55, 95% CI 0.32–0.95), whereas maximum stenosis, CACS, and PFAI showed no consistent independent associations. The clinical reference model had an AUC of 0.781; adding minimum CT-FFR increased this to 0.794 (P=0.031), improving risk reclassification (NRI=0.090). Including all imaging variables further improved the AUC to 0.800 (P=0.023) with an NRI of 0.160. For the RCRI (baseline AUC 0.597), adding minimum CT-FFR significantly increased the AUC to 0.655 (P=0.022).
Conclusion
From CCTA-derived parameters, patients with better overall coronary function have a lower risk of MINS. Specifically, CT-FFR in this study demonstrated its correlation with MINS and its incremental predictive value beyond clinical and intraoperative information.Figure 1Figure 2