THE ROLE OF CORONARY ARTERY MSCT IN ASSESSING CARDIAC RISK IN PATIENTS WITH CANCER BEFORE UPCOMING SURGERY

Highlights The article shows the positive role of consulting a cardiologist and the prospects of using multispiral computed tomography of the coronary arteries to assess the cardiological risk in patients with cancer before the upcoming surgery. Abstract Aim. To study the possibilities of using multispiral computed tomography (MSCT) of coronary arteries with the following determination of the calcium index for additional risk assessment and risk restratification in patients with cancer before the upcoming surgical intervention. Methods. The pilot study included 26 patients (median age was 68.6 years, 69% men, 31% women) with malignant neoplasms undergoing additional examination and risk stratification before the high-risk surgery. All patients were examined by a cardiologist who assessed the perioperative cardiovascular risk during noncardiac surgery. Moreover, patients underwent the assessment of the pre-test probability (PTP) and the clinical probability of obstructive coronary artery disease (CAD). After that, all patients underwent MSCT of the coronary arteries with determination of the calcium index (50%) or MSCT of the coronary arteries with contrast (50%). In order to establish the severity of the coronary lesion, patients underwent selective coronary angiography (SCA). The randomization of patients was performed taking into account the limitations of contrast-enhanced coronary artery MSCT. Results. When assessing the clinical symptoms of angina pectoris, patients were more likely to have atypical and non-anginal pain (in 38% of cases, respectively) than typical anginal pain (only in 27% of patients). At the same time, the median PTP of obstructive CAD was 24%, which corresponded to a high risk of obstructive CAD. An additional assessment of the clinical probability of CAD classified 61% of patients as a group with a very high probability of obstructive CAD. According to the results of the examination, one patient (4%) with high coronary calcium and 2 patients (8%) with hemodynamically significant stenosis were referred for SCA. Of these, all (100%) patients had significant coronary artery stenosis > 70%. According to the results of the angiographic examination, preventive coronary artery stenting was indicated in two cases, and conservative tactics were chosen in one case. Conclusion. The results of this study highlight the prospects of using MSCT of coronary arteries to assess the cardiological risk in patients with cancer before the upcoming surgery. Such diagnostic and therapeutic tactic may minimize the number of perioperative cardiac complications.