Coronary CTA Plus CT-derived Fractional Flow Reserve-guided Management Of Patients Undergoing Peripheral Vascular Surgery

Introduction: Patients with peripheral artery disease (PAD) have high risk for adverse cardiac events and poor long-term survival due to coexisting coronary artery disease (CAD) which is often asymptomatic and undiagnosed. Guidelines recommend no pre-operative cardiac testing of vascular surgery patients without cardiac symptoms and thus the severity of CAD is largely unknown. We conducted a prospective IRB-approved study of systematic pre-op coronary CT angiography (CTA) and CTA-derived fractional flow reserve (FFR-CT) testing to determine the prevalence of asymptomatic lesion-specific coronary ischemia (LSI) and the influence of such testing on patient management.