The value of non-invasive computed tomography coronary angiography in imaging patients with coronary artery bypass grafts

Krysztofiak, Thomas; Ahmad, Faheem; Adams, Jacqueline; Stobo, David; Good, Richard; Byrne, John C.

doi:10.1177/0036933020936274

Cited by 4 publications

(2 citation statements)

References 19 publications

(22 reference statements)

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“…Previous observational studies have suggested upfront CTCA may reduce the exposure of patients to contrast, radiation, and the clinical risks of invasive procedures. 14 , 15 , 21 A recently presented RCT (GREECE [Computed Tomography Coronary Angiography in Patients With a Previous Coronary Artery Bypass Graft Surgery Trial]) has provided some preliminary data. 22 , 23 In GREECE, 153 patients with previous CABG and a clinical indication for coronary angiography were randomized to CTCA+ICA (n=84) or ICA alone (n=69).…”

Section: Discussionmentioning

confidence: 99%

Computed Tomography Cardiac Angiography Before Invasive Coronary Angiography in Patients With Previous Bypass Surgery: The BYPASS-CTCA Trial

Jones,

Beirne,

Kelham

et al. 2023

Circulation

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BACKGROUND: Patients with previous coronary artery bypass grafting often require invasive coronary angiography (ICA). However, for these patients, the procedure is technically more challenging and has a higher risk of complications. Observational studies suggest that computed tomography cardiac angiography (CTCA) may facilitate ICA in this group, but this has not been tested in a randomized controlled trial. METHODS: This study was a single-center, open-label randomized controlled trial assessing the benefit of adjunctive CTCA in patients with previous coronary artery bypass grafting referred for ICA. Patients were randomized 1:1 to undergo CTCA before ICA or ICA alone. The co–primary end points were procedural duration of the ICA (defined as the interval between local anesthesia administration for obtaining vascular access and removal of the last catheter), patient satisfaction after ICA using a validated questionnaire, and the incidence of contrast-induced nephropathy. Linear regression was used for procedural duration and patient satisfaction score; contrast-induced nephropathy was analyzed using logistic regression. We applied the Bonferroni correction, with P <0.017 considered significant and 98.33% CIs presented. Secondary end points included incidence of procedural complications and 1-year major adverse cardiac events. RESULTS: Over 3 years, 688 patients were randomized with a median follow-up of 1.0 years. The mean age was 69.8±10.4 years, 108 (15.7%) were women, 402 (58.4%) were White, and there was a high burden of comorbidity (85.3% hypertension and 53.8% diabetes). The median time from coronary artery bypass grafting to angiography was 12.0 years, and there were a median of 3 (interquartile range, 2 to 3) grafts per participant. Procedure duration of the ICA was significantly shorter in the CTCA+ICA group (CTCA+ICA, 18.6±9.5 minutes versus ICA alone, 39.5±16.9 minutes [98.33% CI, −23.5 to −18.4]; P <0.001), alongside improved mean ICA satisfaction scores (1=very good to 5=very poor; −1.1 difference [98.33% CI, −1.2 to −0.9]; P <0.001), and reduced incidence of contrast-induced nephropathy (3.4% versus 27.9%; odds ratio, 0.09 [98.33% CI, 0.04–0.2]; P <0.001). Procedural complications (2.3% versus 10.8%; odds ratio, 0.2 [95% CI, 0.1–0.4]; P <0.001) and 1-year major adverse cardiac events (16.0% versus 29.4%; hazard ratio, 0.4 [95% CI, 0.3–0.6]; P <0.001) were also lower in the CTCA+ICA group. CONCLUSIONS: For patients with previous coronary artery bypass grafting, CTCA before ICA leads to reductions in procedure time and contrast-induced nephropathy, with improved patient satisfaction. CTCA before ICA should be considered in this group of patients. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03736018.

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Section: Discussionmentioning

confidence: 99%

Computed Tomography Cardiac Angiography Before Invasive Coronary Angiography in Patients With Previous Bypass Surgery: The BYPASS-CTCA Trial

Jones,

Beirne,

Kelham

et al. 2023

Circulation

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“…In this issue of SMJ, Atrah Hasan 1 provides a background to cytokine storm and strategy to deal with. Krysztofiak et al 2 report experience of non-invasive CT scan in assessing bypass graft condition and Demir Gu¨ndo gmus¸et al 3 describe coronary intervention in elderly population. These publications enhance our understanding of cardiovascular disease which remains one of the major killers in Scotland and world over.…”

Section: Ghulam Nabimentioning

confidence: 99%

Impact of Covid-19 pandemic on healthcare delivery, socio-political and economics

Nabi

2020

Scott Med J

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The effect of CTCA guided selective invasive graft assessment on coronary angiographic parameters and outcomes: Insights from the BYPASS-CTCA trial

Kelham,

Beirne,

Rathod

et al. 2024

Journal of Cardiovascular Computed Tomography

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The value of non-invasive computed tomography coronary angiography in imaging patients with coronary artery bypass grafts

Cited by 4 publications

References 19 publications

Computed Tomography Cardiac Angiography Before Invasive Coronary Angiography in Patients With Previous Bypass Surgery: The BYPASS-CTCA Trial

Computed Tomography Cardiac Angiography Before Invasive Coronary Angiography in Patients With Previous Bypass Surgery: The BYPASS-CTCA Trial

Impact of Covid-19 pandemic on healthcare delivery, socio-political and economics

The effect of CTCA guided selective invasive graft assessment on coronary angiographic parameters and outcomes: Insights from the BYPASS-CTCA trial

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