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Although clinically unsuspected PE can be detected in patients undergoing coronary computed tomography angiography (CTA), its natural history remains unclear. The purpose of our study was to assess the prevalence of unsuspected PE, especially after open-heart surgery, and to determine its clinical significance and natural history.
We retrospectively reviewed coronary CTA performed in 1,296 consecutive cases (1,083 patients; 677 males, 406 females, mean 65.8 years) from March 2003 to June 2007. Coronary CTA was acquired using a 16-MDCT scanner. The mean clinical follow up period was 1597 days.
In 1083 patients, 213 patients (19.7%) underwent open-heart surgery and 94 patients (8.7%) within 3 months after open-heart surgery. Thirty-two of 1,083 patients (3.0%) had unsuspected PE. There was no significant difference in survival free from death and acute PE between patients with and without unsuspected PE (Kaplan-Meier estimate; Logrank test p=0.28). Unsuspected PE was seen in 14 of 213 patients (6.6%) with open-heart surgery, and in 10 of 94 patients (10.6%) within 3 months after open-heart surgery. In the 94 patients, not receiving anticoagulant therapy (ACT) was an independent risk factor (p=0.019) of unsuspected PE. There was no significant difference between PE group and no PE group in the use of aspirin (p=0.64), BMI (p=0.087), the use of heart-lung machine (p=0.63), the durations of central venous catheterization (p=0.19), and the days of bed rest after surgery (p=0.90). Although only 2 of the 14 patients with unsuspected PE after open-heart surgery within 3 months received ACT, no critical event such as cardiac death and acute PE occurred with them. Moreover, the thrombus disappeared regardless of its size and location after repeated CTA in 7 of 9 patients, of which 6 patients had not received ACT.
Coronary CTA after open-heart surgery revealed a high relevance of unsuspected PE (6.6%), especially within 3 months (10.6%). Not receiving ACT was an independent risk factor of unsuspected PE after open-heart surgery. Long-term clinical outcomes were favorable in patients with unsuspected PE after open-heart surgery even without ACT.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Imaging: CT/Multimodality II
Abstract Category: 20. Imaging: CT/Multimodality
Presentation Number: 1141-341
- 2013 American College of Cardiology Foundation