CORONARY EVALUATION BY COMPUTED TOMOGRAPHY VERSUS CORONARY ANGIOGRAPHY IN PATIENTS UNDERGOING VALVE SURGERY

Abstract

The study was conducted to assess the efficacy of coronary computed tomography for coronary evaluation in patients undergoing valvular surgery, keeping coronary angiography as gold standard.This prospective study was conducted in the Department of Cardiology of Punjab Institute of Cardiology/ Quaid-E-Azam Medical College Bahawalpur from March 2024 to March 2025. A total of 100 patients with valvular heart disease undergoing preoperative coronary evaluation were included in the study.All patients underwent computed tomography angiography and coronary angiography within 7 days of admission.Angiography was performed by cardiologists with at least 10 years or more experience of catheterization with common femoral artery or radial artery as a puncture site.Dual source 64 CT system with non-ionic, low-osmolar contrast was used to perform CCTA.Each 18 segment of coronary artery was evaluated separately, main coronary artery was assessed as a whole and significant stenosis in each patient evaluated. The results showed that in total, 1800 segments were evaluated, among which 270 were excluded due to being absent, hence, 1530 segments were used for final comparison. 1056 (68.3%) were normal, 459 (30%) had insignificant stenosis, 77 (5%) had significant stenosis and 10 (0.6%) were completely occluded on CCTA. CCTA had a sensitivity of 88.3%, sensitivity of 98.5%, positive predictive value of 86.6%, negative predictive value of 98.5% and overall accuracy of 98.9% for identification of significant stenosis in segments.An overall sensitivity for all vessels was 85%, specificity & positive predictive value was 100% and negative predictive value was 98% indicating excellent accuracy of 98%. In conclusion, coronary computed tomography angiography has a high diagnostic accuracy for detecting coronary artery disease and stenosis in patients before valvular surgery.