The coronary CT angiography vision protocol: a prospective observational imaging cohort study in patients undergoing non-cardiac surgery
- Tej Sheth1,
- Craig Butler2,
- Benjamin Chow3,
- M T V Chan4,
- Ayesha Mitha5,
- Peter Nagele6,
- Vikas Tandon1,
- Lori Stewart7,
- Michelle Graham2,
- G Y S Choi4,
- T Kisten8,
- P K Woodard9,
- Andrew Crean10,
- Y F Abdul Aziz11,
- G Karthikeyan12,
- C K Chow13,
- W Szczeklik14,
- M Markobrada15,
- T. Mastracci16,
- P J Devereaux17,
- for the CTA VISION Investigators
- 1Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- 2Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
- 3Department of Medicine (Cardiology) and Radiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- 4Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
- 5Departments of Radiology, Inokusi Hospital, Durban, South Africa
- 6Division of Clinical and Translational Research, Department of Anesthesiology, Washington University, St. Louis, Washington, USA
- 7Department of Radiology, McMaster University, Hamilton, Ontario, Canada
- 8Department of Anesthesia, Inokusi Hospital, Durban, South Africa
- 9Division of Radiology, Washington University, St. Louis, Washington, USA
- 10Division of Cardiology, University Health Network, Toronto, Ontario, Canada
- 11Department of Biomedical Imaging, University Malaya Research Imaging Centre, Kuala Lumpur, Malaysia
- 12Division of Cardiology, All India Institute of Medical Sciences, New Delhi, India
- 13Department of Cardiology, Westmead Hospital & The George Institute for Global Health, The University of Sydney, Sydney, Australia
- 14Departments of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland
- 15Division of General Internal Medicine, University of Western Ontario, London, Ontario, Canada
- 16Endovascular and Vascular Surgery Department, Cleveland Clinic Foundation, Cleveland, Ohio, USA
- 17Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Correspondence to Dr Tej Sheth;
Contributors All authors provided intellectual input into the editing of the manuscript and preparation for publication.
- Received 18 November 2011
- Accepted 18 June 2012
- Published 31 July 2012
Introduction At present, physicians have a limited ability to predict major cardiovascular complications after non-cardiac surgery and little is known about the anatomy of coronary arteries associated with perioperative myocardial infarction. We have initiated the Coronary CT Angiography (CTA) VISION Study to (1) establish the predictive value of coronary CTA for perioperative myocardial infarction and death and (2) describe the coronary anatomy of patients that have a perioperative myocardial infarction.
Methods and analysis The Coronary CTA VISION Study is prospective observational study. Preoperative coronary CTA will be performed in 1000–1500 patients with a history of vascular disease or at least three cardiovascular risk factors who are undergoing major elective non-cardiac surgery. Serial troponin will be measured 6–12 h after surgery and daily for the first 3 days after surgery. Major vascular outcomes at 30 days and 1 year after surgery will be independently adjudicated.
Ethics and dissemination Coronary CTA results in a measurable radiation exposure that is similar to a nuclear perfusion scan (10–12 mSV). Treating physicians will be blinded to the CTA results until 30 days after surgery in order to provide the most unbiased assessment of its prognostic capabilities. The only exception will be the presence of a left main stenosis >50%. This approach is supported by best available current evidence that, excluding left main disease, prophylatic revascularisation prior to non-cardiac surgery does not improve outcomes. An external safety and monitoring committee is overseeing the study and will review outcome data at regular intervals. Publications describing the results of the study will be submitted to major peer-reviewed journals and presented at international medical conferences.
- Coronary heart disease
- Radiology & Imaging
- Computed tomography
- Radiology & Imaging
- Cardiovascular imaging
Funding This work is supported by grants from Canadian Institutes of Health Research, the Hamilton Health Sciences New Investigator Fund, the McMaster University Division of Cardiology, the University of Western Ontario Department of Radiology and the University of Western Ontario Division of General Internal Medicine. The study funders have no role in study design, data collection, data analysis and interpretation, drafting of manuscripts or the decision to submit the report for publication.
Competing interests None.
Provenance and peer review Not commissioned; internally peer reviewed.
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