The benefit of 64-MDCT prior to invasive coronary angiography in symptomatic post-CABG patients

Abstract

In conclusion, 64-MDCT has a high diagnostic accuracy in detecting bypass graft stenosis and occlusions, and 64-MDCT based treatment advice was correct in 88.2% of patients.

Diagnostic accuracy of dual-source coronary computed tomography angiography in patients after bypass grafting

“…Sixty-four multidetector CT technology reported sensitivities between 85% and 100% with specificities between 89% and 97% for the detection of significant graft disease in symptomatic post-CABG patients [5][6][7][8][9][10][11][12]. In addition, almost all studies showed satisfactory graft assessability (83-100%) with exclusion of a limited number of examinations because of metal clips, calcification and/or motion artefacts.…”

“…Most publications on the diagnostic accuracy of 64-detector CCTA have reported sensitivities between 80% and 93% with specificities between 76% and 90% for the detection of significant coronary artery disease [6,7,9,10,12]. Moreover, sensitivities between 86% and 96% with specificities between 86% and 94% for assessment of significant lesions in non-grafted coronary arteries and distal runoffs were demonstrated.…”

“…Rapid advances in multidetector coronary computed tomography angiography (CCTA) have facilitated noninvasive visualization of coronary arteries [4]. Results of studies using 64-detector CCTA have shown good and unsatisfactory accuracy for the detection of obstructive disease in bypass grafts and native coronary circulation, respectively [5][6][7][8][9][10][11][12]. Thus, performance of CCTA for evaluation of graft patency in symptomatic post-CABG patients is considered an appropriate indication, whereas assessment of native coronary arteries after CABG is not indicated in the CCTA appropriateness criteria [13].…”

New Frontiers in the Evaluation of Cardiac Patients for Noncardiac Surgery

“…20 MDCT also has high diagnostic accuracy in detecting bypass graft stenosis and occlusions in symptomatic patients after coronary artery bypass grafting, which might potentially reduce dramatically the number of unnecessary invasive angiographies performed in these patients. 21 However, although the MDCT technique has been extensively evaluated for its accuracy for detection of CAD compared with standard coronary angiography, 6,19,20,22 it has not been applied for the routine evaluation of cardiac patients for noncardiac surgery and, to date, is not a recommended technique for perioperative risk stratification.…”

Assessment of Coronary Artery Bypass Graft (CABG) Patency and Graft Disease Using Multidetector Computed Tomography (MDCT)

“…Moreover, 3-dimensional (3D) image processing and advanced volumetric visualization techniques now allow radiologists and cardiologists to evaluate coronary grafts in multiple planes using various projections. With the capability of acquiring 3D data volumes along with its tomographic nature, it shares many of the advantages of intravascular ultrasound and thus has the potential to enhance the practice of percutaneous 162 coronary intervention (PCI) in the catheterization laboratory by providing data which was difficult to obtain by invasive coronary angiography (Dikkers et al, 2007;Vembar et al, 2003). Recent studies using 64-slice MDCT have reported sensitivity and specificity values of 95% to 100% and 93% to 100%, respectively, for graft occlusion and high-grade stenosis with > 50% luminal narrowing (Table 1).…”