The ability of computed tomography angiography to predict 5-year mortality in the SYNTAX III REVOLUTION trial

Masuda, Shinichiro; Serruys, Patrick W.; Mushtaq, Saima; Tanaka, Kaoru; Mandry, Damien; Buechel, Ronny R.; Digne, Franck; Schneider, Ulrich; Pompilio, Giulio; La Meir, Mark; Doenst, Torsten; Teichgraber, Ulf; Morel, Marie-Angele; Kotoku, Nozomi; Ninomiya, Kai; Kageyama, Shigetaka; O’Leary, Neil; Collet, Carlos; Garg, Scot; de Mey, Johan; Andreini, Daniele; Onuma, Yoshinobu

doi:10.1016/j.jcct.2023.08.006

Cited by 3 publications

(1 citation statement)

References 20 publications

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“…Nevertheless, it is worth mentioning that vital prognosis at 5-year follow-up, using either ICA or CCTA, was comparable. 8 In addition, physiological assessment with fractional flow reserve derived from CCTA (FFR CT , HeartFlow, Mountain View, CA, USA) has refined the planning of the optimal revascularization strategy in patients with multivessel disease. 9–11 …”

Section: Introductionmentioning

confidence: 99%

Coronary bypass surgery guided by computed tomography in a low-risk population

Serruys,

Kageyama,

Pompilio

et al. 2024

European Heart Journal

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Background and Aims In patients with three-vessel disease and/or left main disease, selecting revascularization strategy based on coronary computed tomography angiography (CCTA) has a high level of virtual agreement with treatment decisions based on invasive coronary angiography (ICA). Methods In this study, coronary artery bypass grafting (CABG) procedures were planned based on CCTA without knowledge of ICA. The CABG strategy was recommended by a central core laboratory assessing the anatomy and functionality of the coronary circulation. The primary feasibility endpoint was the percentage of operations performed without access to the ICA. The primary safety endpoint was graft patency on 30-day follow-up CCTA. Secondary endpoints included topographical adequacy of grafting, major adverse cardiac and cerebrovascular (MACCE), and major bleeding events at 30 days. The study was considered positive if the lower boundary of confidence intervals (CI) for feasibility was ≥75% (NCT04142021). Results The study enrolled 114 patients with a mean (standard deviation) anatomical SYNTAX score and Society of Thoracic Surgery score of 43.6 (15.3) and 0.81 (0.63), respectively. Unblinding ICA was required in one case yielding a feasibility of 99.1% (95% CI 95.2%–100%). The concordance and agreement in revascularization planning between the ICA- and CCTA-Heart Teams was 82.9% with a moderate kappa of 0.58 (95% CI 0.50–0.66) and between the CCTA-Heart Team and actual treatment was 83.7% with a substantial kappa of 0.61 (95% CI 0.53–0.68). The 30-day follow-up CCTA in 102 patients (91.9%) showed an anastomosis patency rate of 92.6%, whilst MACCE was 7.2% and major bleeding 2.7%. Conclusions CABG guided by CCTA is feasible and has an acceptable safety profile in a selected population of complex coronary artery disease.

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Section: Introductionmentioning

confidence: 99%

Coronary bypass surgery guided by computed tomography in a low-risk population

Serruys,

Kageyama,

Pompilio

et al. 2024

European Heart Journal

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Coronary chronic total occlusion on coronary CT angiography: what radiologists should know?

Xu,

Ma,

Chen

et al. 2024

Insights Imaging

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Coronary chronic total occlusion (CTO) often occurs in patients with obstructive coronary artery disease, which remains one of the greatest challenges for interventional cardiologists. Coronary computed tomography angiography (CCTA) with its emerging post-processing techniques can provide a detailed assessment of CTO lesions before percutaneous coronary intervention (PCI), playing an important role in the clinical management of CTO PCI, from early diagnosis, pre-procedural outcome prediction, the crossing algorithm planning, intraprocedural guidance, and finally post-procedural assessment and follow-up. In addition, the feasibility of CT perfusion (CTP) in patients with CTO has been validated. Combined CCTA and CTP have the great potential to be the one-stop-shop imaging modality for assessing both anatomy and function of CTO lesions. This review aims to make radiologists understand the role of CCTA in the diagnosis and assessment of CTO lesions, thus assisting interventionalists in optimizing CTO PCI crossing strategies with the expertise of radiologists.Critical relevance statement The anatomical features of CTO on CCTA can reveal the complexity of CTO lesions and are associated with CTO PCI outcome, thus helping interventionalists optimize CTO PCI crossing strategies.Key points • CTO is the common lesion in invasive coronary angiography, and CTO PCI is technically difficult and its success rate is relatively low.• Length, collaterals, and attenuation-related signs can help distinguish CTO from subtotal occlusion.• The anatomical features of CTO lesions can help grade the difficulty of CTO PCI and predict procedural outcomes and long-term outcomes of CTO PCI.• The real-time fusion of CCTA with fluoroscopic angiography can be applied in highly complicated CTO lesions.• After CTO PCI, CCTA can help guide a second CTO PCI re-entry or follow up stent patency. Graphical Abstract

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Kugel’s Artery in Coronary Computed Tomography Angiography in a Patient with Left Main Subtotal Stenosis

Gać,

Głuszczyk,

Plizga

et al. 2024

Diagnostics

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The artery of Kugel is defined as a rare anatomical variant of the coronary arteries. It consists of an anastomotic connection between the branches of the right coronary artery (RCA) and the left circumflex artery (LCx). In patients with coronary artery occlusion, the presence of this connection bypassing the area of the occluded vessel may be a factor that prevents significant necrosis of a specific area of the myocardium. Most cases are detected by invasive coronary angiography. We present images from coronary computed tomography angiography (CCTA), which documented the existence of Kugel’s artery in a 67-year-old patient with subtotal stenosis of the left main artery. The presented images clearly indicate that CCTA can visualize the existing rescue collateral circulation in patients with significant coronary artery disease.

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The ability of computed tomography angiography to predict 5-year mortality in the SYNTAX III REVOLUTION trial

Cited by 3 publications

References 20 publications

Coronary bypass surgery guided by computed tomography in a low-risk population

Coronary bypass surgery guided by computed tomography in a low-risk population

Coronary chronic total occlusion on coronary CT angiography: what radiologists should know?

Kugel’s Artery in Coronary Computed Tomography Angiography in a Patient with Left Main Subtotal Stenosis

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