Preoperative invasive coronary angiography before non-coronary cardiac surgery: diagnostic yield and impact on management in an african population
J P Herbst, J Hitzeroth, T PennelAbstract
Background
Preoperative invasive coronary angiography is widely performed before non-coronary cardiac surgery to exclude occult coronary artery disease, yet its diagnostic yield and clinical value remain uncertain in settings where non-atherosclerotic valvular disease is common. In such populations, routine angiography may expose low-risk patients to unnecessary procedural risk without meaningful impact on management.
Methods
We conducted a retrospective study of 524 adult patients who underwent invasive coronary angiography as part of preoperative assessment for non-coronary cardiac surgery at a tertiary referral centre in sub-Saharan Africa between 2022 and 2025. Demographic characteristics, cardiovascular risk factors, clinical symptoms, echocardiographic findings and coronary angiographic results were analysed to determine the prevalence and predictors of coronary artery disease and to assess its impact on surgical management and early postoperative outcomes.
Results
Coronary artery disease was identified in 29.2% of patients; however, only 18.9% had significant or obstructive disease. Traditional cardiovascular risk factors, including older age, male sex, hypertension, diabetes mellitus, dyslipidaemia and smoking, were associated with coronary artery disease. Angina emerged as the strongest clinical predictor. Among patients with non-aortic valvular disease who did not report angina, significant coronary artery disease was rare. Despite frequent detection of coronary abnormalities, angiographic findings altered surgical management in only 9% of cases, primarily through concomitant coronary artery bypass grafting. In-hospital mortality and postoperative arrhythmia rates were low and did not differ significantly between patients with and without coronary artery disease.
Conclusions
In this African cohort undergoing non-coronary cardiac surgery, routine invasive coronary angiography demonstrated limited diagnostic and therapeutic yield in patients without high-risk clinical features. Simple clinical variables, particularly symptom status and valve pathology, identified patients with a very low likelihood of significant coronary artery disease. These findings support a selective, risk-based approach to preoperative coronary assessment, reserving invasive angiography for patients most likely to benefit while avoiding low-yield testing in asymptomatic, low-risk individuals.