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Muscogiuri G, Weir-McCall JR, Tregubova M, Ley S, Loewe C, Alkadhi H, Salgado R, Vliegenthart R, Williams MC. ESR Essentials: imaging in stable chest pain - practice recommendations by ESCR. Eur Radiol 2024; 34:6559-6567. [PMID: 38625611 DOI: 10.1007/s00330-024-10739-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/27/2024] [Accepted: 03/04/2024] [Indexed: 04/17/2024]
Abstract
Stable chest pain is a common symptom with multiple potential causes. Non-invasive imaging has an important role in diagnosis and guiding management through the assessment of coronary stenoses, atherosclerotic plaque, myocardial ischaemia or infarction, and cardiac function. Computed tomography (CT) provides the anatomical evaluation of coronary artery disease (CAD) with the assessment of stenosis, plaque type and plaque burden, with additional functional information available from CT fractional flow reserve (FFR) or CT myocardial perfusion imaging. Stress magnetic resonance imaging, nuclear stress myocardial perfusion imaging, and stress echocardiography can assess myocardial ischaemia and other cardiac functional parameters. Coronary CT angiography can be used as a first-line test for many patients with stable chest pain, particularly those with low to intermediate pre-test probability. Functional testing may be considered for patients with known CAD, where the clinical significance is uncertain based on anatomical testing, or in patients with high pre-test probability. This practice recommendations document can be used to guide the selection of non-invasive imaging for patients with stable chest pain and provides brief recommendations on how to perform and report these diagnostic tests. KEY POINTS: The selection of non-invasive imaging tests for patients with stable chest pain should be based on symptoms, pre-test probability, and previous history. Coronary CT angiography can be used as a first-line test for many patients with stable chest pain, particularly those with low to intermediate pre-test probability. Functional testing can be considered for patients with known CAD, where the clinical significance of CAD is uncertain based on anatomical testing, or in patients with high pre-test probability. KEY RECOMMENDATIONS: Non-invasive imaging is an important part of the assessment of patients with stable chest pain. The selection of non-invasive imaging test should be based on symptoms, pre-test probability, and previous history. (Level of evidence: High). Coronary CT angiography can be used as a first line test for many patients with stable chest pain, particularly those with low to intermediate pre-test probability. CT provides information on stenoses, plaque type, plaque volume, and if required functional information with CT fractional flow reserve or CT perfusion. (Level of evidence: High). Functional testing can be considered for patients with known CAD, where the clinical significance of CAD is uncertain based on anatomical testing, or in patients with high pre-test probability. Stress MRI, SPECT, PET, and echocardiography can provide information on myocardial ischemia, along with cardiac functional and other information. (Level of evidence: Medium).
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Affiliation(s)
| | - Jonathan R Weir-McCall
- Department of Radiology, Royal Papworth Hospital, Cambridge, UK
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Mariia Tregubova
- Department of Radiology, Amosov National Institute of Cardiovascular Surgery NAMS of Ukraine, Kyiv, Ukraine
| | - Sebastian Ley
- Department of Radiology, Internistisches Klinikum München Süd, Munich, Germany
| | - Christian Loewe
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Wien, Austria
| | - Hatem Alkadhi
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Rodrigo Salgado
- Department of Radiology, Antwerp University Hospital & Holy Heart Lier, Antwerp, Belgium
| | - Rozemarijn Vliegenthart
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Tsigkas G, Toulgaridis F, Apostolos A, Kalogeropoulos A, Karamasis GV, Vasilagkos G, Pappas L, Toutouzas K, Tsioufis K, Korkonikitas P, Tsiafoutis I, Hamilos M, Ziakas A, Kanakakis I, Moulias A, Zampakis P, Davlouros P. CCTA-Guided Invasive Coronary Angiography in Patients With CABG: A Multicenter, Randomized Study. Circ Cardiovasc Interv 2024; 17:e014045. [PMID: 39286899 DOI: 10.1161/circinterventions.124.014045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 06/19/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND Coronary computed tomography angiography (CCTA) in patients with post-coronary artery bypass graft (CABG) has a high diagnostic accuracy for visualization of grafts. Invasive coronary angiography (ICA) in patients with CABG is associated with increased procedural time, contrast agent administration, radiation exposure, and complications, compared with non-CABG patients. The aim of this multicenter, randomized controlled trial was to compare the strategy of CCTA-guided ICA versus classic ICA in patients with prior CABG. METHODS Patients with prior CABG were randomly assigned (1:1 ratio) to have a CCTA before ICA (CCTA-ICA, group A) or not (ICA-only, group B). The primary end point of the study was the total volume (milliliters) of the contrast agent administered. RESULTS A total of 251 patients were randomized, and 225 were included in analysis; 110 in group A and 115 in group B. The total contrast volume was higher in group A (184.5 [143-255] versus 154 [102-240] mL; P=0.001). The contrast volume administered during the invasive procedure was lower in group A (101.5 [60-151] versus 154 [102-240]; P<0.001). Total fluoroscopy time was decreased in group A (480 [259-873] versus 594 [360-1080] seconds; P=0.027), but total effective dose was increased (24.1 [17.7-32] versus 10.8 [5.6-18] mSv; P<0.001). The rate of contrast-induced nephropathy, periprocedural complications, and major adverse cardiac events during 3 to 5 and 30 days did not differ significantly between the 2 groups. CONCLUSIONS A CCTA-directed ICA strategy for patients with CABG is associated with expedition of the invasive procedure, and less fluoroscopy time, at the cost of higher total contrast volume and effective radiation dose, compared with the classic ICA approach. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT04631809.
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Affiliation(s)
- Grigorios Tsigkas
- Department of Cardiology (G.T., G.V., A.M., P.D.), University Hospital of Patras, Greece
| | - Fotios Toulgaridis
- Second Department of Cardiology (F.T.), "Evangelismos" General Hospital of Athens, Greece
| | - Anastasios Apostolos
- First Department of Cardiology, "Hippocration" University Hospital of Athens, Greece (A.A., K. Toutouzas, K. Tsioufis)
| | | | - Grigoris V Karamasis
- Second Department of Cardiology, "Attikon'' University Hospital of Athens, Greece (G.V.K.)
| | - Georgios Vasilagkos
- Department of Cardiology (G.T., G.V., A.M., P.D.), University Hospital of Patras, Greece
| | - Loukas Pappas
- First Department of Cardiology (L.P.), "Evangelismos" General Hospital of Athens, Greece
| | - Konstantinos Toutouzas
- First Department of Cardiology, "Hippocration" University Hospital of Athens, Greece (A.A., K. Toutouzas, K. Tsioufis)
| | - Konstantinos Tsioufis
- First Department of Cardiology, "Hippocration" University Hospital of Athens, Greece (A.A., K. Toutouzas, K. Tsioufis)
| | | | - Ioannis Tsiafoutis
- First Department of Cardiology, "Red Cross" General Hospital of Athens, Greece (I.T.)
| | - Michalis Hamilos
- Department of Cardiology, "PAGNI" University Hospital of Heraklion, Creta, Greece (M.H.)
| | - Antonios Ziakas
- First Department of Cardiology, "AHEPA" University Hospital of Thessaloniki, Greece (A.Z.)
| | - Ioannis Kanakakis
- Department of Cardiology, "Alexandra" General Hospital of Athens, Greece (I.K.)
| | - Athanasios Moulias
- Department of Cardiology (G.T., G.V., A.M., P.D.), University Hospital of Patras, Greece
| | - Petros Zampakis
- Department of Radiology (P.Z.), University Hospital of Patras, Greece
| | - Periklis Davlouros
- Department of Cardiology (G.T., G.V., A.M., P.D.), University Hospital of Patras, Greece
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Vrints C, Andreotti F, Koskinas KC, Rossello X, Adamo M, Ainslie J, Banning AP, Budaj A, Buechel RR, Chiariello GA, Chieffo A, Christodorescu RM, Deaton C, Doenst T, Jones HW, Kunadian V, Mehilli J, Milojevic M, Piek JJ, Pugliese F, Rubboli A, Semb AG, Senior R, Ten Berg JM, Van Belle E, Van Craenenbroeck EM, Vidal-Perez R, Winther S. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J 2024:ehae177. [PMID: 39210710 DOI: 10.1093/eurheartj/ehae177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
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Zhang F, Tian M, Wang X, Zhang H, Zhou X, Liu R, Liu R, Jin Z, Zhang C, Wang X. Rationale and design of a single-center randomized trial to compare the graft patency between the radial artery and the no-touch saphenous vein in coronary artery bypass grafting surgery (GRAFT-CAB Study). Am Heart J 2024; 274:46-53. [PMID: 38710379 DOI: 10.1016/j.ahj.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 05/01/2024] [Accepted: 05/01/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Previous studies suggested only the radial artery and the No-touch (NT) technique were effective in reducing graft occlusion after coronary artery bypass grafting (CABG) surgery. However, there is no randomized trial comparing these 2 graft conduits. The optimum second conduit for CABG remains undetermined. MATERIALS AND METHODS This study is a prospective, single-center randomized clinical trial, aiming to compare the graft patency between the radial artery and the NT vein graft. All patients undergoing isolated CABG with left internal mammary artery (LIMA) plus at least 2 additional grafts will be considered eligible. About 774 cases (516 in the radial artery group and 258 in the NT vein group) will be enrolled in over 1 to 2 years. Participants will be randomized and allocated to two bypass strategies: the LIMA plus 1 radial artery and 1 conventional vein graft, or the LIMA plus 2 NT vein grafts. The primary outcome is graft occlusion at 1 year after CABG evaluated by CT angiography. The secondary outcomes include graft occlusion at 3 and 5 years and major adverse cardiac or cerebrovascular events at 1, 3, and 5 years follow-ups. DISCUSSION This study will define whether or not the NT vein has a lower graft occlusion rate than the radial artery in short and mid-term follow-ups, and provide new evidence for the second conduit choice in CABG surgery. TRIAL REGISTRATION ClinicalTrials.gov NCT06014047. Registered on October 15th, 2023.
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Affiliation(s)
- Fengqing Zhang
- Department of Surgery, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meice Tian
- Department of Surgery, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaohu Wang
- Department of Surgery, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haotian Zhang
- Department of Surgery, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xingtong Zhou
- Department of Surgery, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rui Liu
- Department of Surgery, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rui Liu
- Department of Surgery, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zejian Jin
- Department of Surgery, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Changwei Zhang
- Department of Surgery, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xianqiang Wang
- Department of Surgery, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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5
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Tekinhatun M, Akbudak İ, Özbek M, Turmak M. Comparison of coronary CT angiography and invasive coronary angiography results. Ir J Med Sci 2024:10.1007/s11845-024-03745-y. [PMID: 38965116 DOI: 10.1007/s11845-024-03745-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 06/25/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION Coronary artery disease (CAD) is a leading cause of death worldwide. Accurate diagnosis and management are critical. Non-invasive imaging, such as coronary computed tomography angiography (CCTA), is vital for early diagnosis and treatment planning. This study evaluates the accuracy of CAD-Reporting and Data System (CAD-RADS) scoring and the compatibility between CCTA and invasive coronary angiography (ICA) in patients suspected of having CAD. MATERIALS AND METHODS From January 1, 2022 to January 15, 2024, 214 patients suspected of CAD underwent both CCTA and ICA. CCTA artifacts led to the exclusion of 32 patients and 128 vessels, leaving 586 vessels for analysis. CAD-RADS scoring categorized coronary stenosis. Diagnostic performance was measured by specificity, sensitivity, accuracy, positive and negative predictive value (NPV). Extracardiac findings were analyzed with a wide field of view (FOV) during CCTA. RESULTS A total of 214 patients (67.3% male, median age 56) were examined. Hypertension, smoking, calcium score, and high-risk plaques correlated with CCTA and ICA CAD-RADS scores; calcium score also related to hypertension, smoking, diabetes, and dyslipidemia (p < 0.05). CCTA showed a sensitivity of 80.8% and NPV of 90.3% for detecting stenosis of 70% or more; for 50% stenosis, sensitivity was 93.5% and NPV 92.1%. Agreement between CCTA and ICA was excellent in bypass patients; stenosis detection in stented patients had 85.7% sensitivity and 96.2% NPV. CONCLUSION This study highlights the importance of CAD-RADS and CCTA in CAD diagnosis and treatment planning. CCTA effectively evaluates stents and grafts, emphasizing the benefits of extracardiac findings and a wide FOV.
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Affiliation(s)
- Muhammed Tekinhatun
- Department of Radiology, Faculty of Medicine, Dicle University, Diyarbakir, Türkiye.
| | - İbrahim Akbudak
- Department of Radiology, Faculty of Medicine, Dicle University, Diyarbakir, Türkiye
| | - Mehmet Özbek
- Department of Cardiology, Faculty of Medicine, Dicle University, Diyarbakir, Türkiye
| | - Mehmet Turmak
- Department of Radiology, Faculty of Medicine, Dicle University, Diyarbakir, Türkiye
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Elmaghraby KM, Demitry SR, Hasaballah EA, Razik NA. Multi-slice CT coronary angiography versus invasive coronary angiography in the assessment of graft patency after coronary artery bypasses graft surgery. Egypt Heart J 2023; 75:100. [PMID: 38055084 DOI: 10.1186/s43044-023-00424-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 11/26/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND The long-term patency of arterial and venous grafts is crucial for the success of CABG. This study was designed to investigate graft patency using 128-slice coronary computed tomography angiography (CCTA) and compared the results with those obtained using invasive coronary angiography (ICA). In this observational cross-sectional study, we included 40 symptomatic post-CABG patients underwent CCTA and ICA within the same month. RESULTS Fifty-five percent were aged more than 60 years, and 80% were males. 67.5% had diabetes, 90% had hypertension, and 30% were smokers. Mean body mass index was 28.89 ± 5.17 kg/m2. Mean duration since CABG was 5.25 ± 4.04 years. In total, 124 native vessels and 97 grafts were assessed using CCTA and ICA. CCTA delineated 8 non-cannulated venous grafts and 6 non-cannulated left internal mammary artery grafts. CCTA required a significantly lower radiation dose (1165.77 ± 123.54 vs. 47,589.78 ± 6967.53, p < 0.001). CONCLUSION CCTA can be as accurate as ICA in assessing bypass grafts with less radiation dose, providing a non-invasive reliable tool for evaluation.
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Affiliation(s)
- Khaled M Elmaghraby
- Department of Cardiovascular Medicine, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
| | - Salwa R Demitry
- Department of Cardiovascular Medicine, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
| | - Eman A Hasaballah
- Department of Cardiovascular Medicine, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
| | - Nady A Razik
- Department of Cardiovascular Medicine, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt.
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7
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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2023; 82:833-955. [PMID: 37480922 DOI: 10.1016/j.jacc.2023.04.003] [Citation(s) in RCA: 72] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2023; 148:e9-e119. [PMID: 37471501 DOI: 10.1161/cir.0000000000001168] [Citation(s) in RCA: 226] [Impact Index Per Article: 226.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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Affiliation(s)
| | | | | | | | | | | | - Dave L Dixon
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | - William F Fearon
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | - Dhaval Kolte
- AHA/ACC Joint Committee on Clinical Data Standards
| | | | | | | | - Daniel B Mark
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | | | | | | | - Mariann R Piano
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
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9
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Bartorelli AL, Andreini D, Giustino G, Dangas G. Coronary CT as a first-line investigation in chronic coronary syndromes: pros and cons. EUROINTERVENTION 2023; 19:459-461. [PMID: 37605808 PMCID: PMC10436067 DOI: 10.4244/eij-e-23-00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Affiliation(s)
- Antonio L Bartorelli
- IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Daniele Andreini
- IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Gennaro Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Hakimjavadi R, DiRienzo L, Rattanawong P, Ayoub C, Visintini SM, Small GR, Chow B. Prognostic Value of Coronary Computed Tomography Angiography in Coronary Artery Bypass Graft Patients Systematic Review and Meta-Analysis. Am J Cardiol 2023; 201:107-115. [PMID: 37354866 DOI: 10.1016/j.amjcard.2023.05.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/28/2023] [Accepted: 05/27/2023] [Indexed: 06/26/2023]
Abstract
We sought to assess the prognostic value of coronary computed tomographic angiography (CCTA) in patients with coronary artery bypass graft (CABG) by meta-analysis. MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scopus were searched for relevant original articles published up to July 2021. CCTA prognostic studies enrolling patients with CABG were screened and included if outcomes included all-cause mortality or major adverse cardiac events. Maximally adjusted hazard ratios (HRs) were extracted for CCTA-derived prognostic factors. HRs were log-transformed and pooled across studies using the DerSimonian-Laird random-effects model and statistical heterogeneity was assessed using the I2 statistic. Of 1,576 screened articles, 4 retrospective studies fulfilled all inclusion criteria. Collectively, a total of 1,809 patients with CABG underwent CCTA (mean [SD] age 67.0 [8.5] years across 3 studies, 81.5% male across 4 studies). Coronary artery disease severity and revascularization were categorized using 2 models: unprotected coronary territories and coronary artery protection score. The pooled HRs from the random-effects models using the most highly adjusted study estimate were 3.64 (95% confidence interval 2.48 to 5.34, I2 = 57.8%, p <0.001; 4 studies) and 4.85 (95% confidence interval 3.17 to 7.43, I2 = 39.9%, p <0.001; 2 studies) for unprotected coronary territories and coronary artery protection score, respectively. In conclusion, in a limited number of studies, CCTA is an independent predictor of adverse events in patients with CABG. Larger studies using uniform models and endpoints are needed.
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Affiliation(s)
| | - Lucas DiRienzo
- Division of Cardiology, University of Ottawa Heart Institute, Canada
| | | | - Chadi Ayoub
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, Arizona
| | - Sarah M Visintini
- Division of Cardiology, University of Ottawa Heart Institute, Canada
| | - Gary R Small
- Division of Cardiology, University of Ottawa Heart Institute, Canada
| | - Benjamin Chow
- Division of Cardiology, University of Ottawa Heart Institute, Canada; Department of Radiology, University of Ottawa, Canada.
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11
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Alboom M, Browne A, Sheth T, Zheng Z, Dagenais F, Noiseux N, Brtko M, Stevens LM, Lee SF, Copland I, Power P, Eikelboom J, Lamy A. Conduit selection and early graft failure in coronary artery bypass surgery: A post hoc analysis of the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) coronary artery bypass grafting study. J Thorac Cardiovasc Surg 2023; 165:1080-1089.e1. [PMID: 35760616 DOI: 10.1016/j.jtcvs.2022.05.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/22/2022] [Accepted: 05/09/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Relative rates of early graft failure and conduit selection in coronary artery bypass grafting (CABG) surgery remain controversial. Therefore, we sought to determine the incidence and determinants of graft failure of the left internal mammary artery (LIMA), radial artery, saphenous vein, and right internal mammary artery (RIMA) 1 year after CABG surgery. METHODS A post hoc analysis of the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) CABG study, involving patients from 83 centers in 22 countries. We completed an analysis of 3480 grafts from 1068 patients who underwent CABG surgery with complete computed tomography angiography data. The primary outcome was graft failure as diagnosed by computed tomography angiography 1 year after surgery. RESULTS Graft failure occurred in 6.4% (68/1068) for LIMA, 9.9% (9/91) for radial artery, 10.4% (232/2239) for saphenous vein, and 26.8% (22/82) for RIMA grafts. The RIMA had a greater rate of graft failure (26.8%) than radial artery (9.9%) and veins (10.4%) (adjusted odds ratio, 2.69; 95% confidence interval, 1.30-5.57; P = .008 and adjusted odds ratio, 2.07; 95% confidence interval, 1.33-3.21; P = .001, respectively). CONCLUSIONS In this international trial dataset, LIMA and radial artery performed as expected, whereas vein grafts performed better. However, high rates of RIMA failure are worrisome and highlight the need for a thorough evaluation of the patency and safety of the RIMA in CABG surgery.
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Affiliation(s)
- Mariam Alboom
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Austin Browne
- Department of Research, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Tej Sheth
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Zhe Zheng
- Department of Cardiovascular Surgery, Fuwai Hospital, Beijing, China
| | - François Dagenais
- Department of Cardiac Surgery, Quebec Heart and Lung Institute affiliated with Laval University, Quebec City, Quebec, Canada
| | - Nicolas Noiseux
- Department of Cardiac Surgery, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | - Miroslav Brtko
- Department of Cardiac Surgery, Fakultní nemocnice Hradec Králové, Hradec Králové, Královéhradecký, Czech Republic
| | - Louis-Mathieu Stevens
- Department of Cardiac Surgery, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | - Shun Fu Lee
- Department of Statistics, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Ingrid Copland
- Department of Perioperative Medicine, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Patricia Power
- Department of Research, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - John Eikelboom
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - André Lamy
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Perioperative Medicine, Population Health Research Institute, Hamilton, Ontario, Canada.
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12
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Takahashi K, Morota T, Ishii Y. A novel transit-time flow metric, diastolic resistance index, detects subcritical anastomotic stenosis in coronary artery bypass grafting. JTCVS Tech 2022; 17:94-103. [PMID: 36820345 PMCID: PMC9938392 DOI: 10.1016/j.xjtc.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 11/01/2022] [Accepted: 11/14/2022] [Indexed: 12/15/2022] Open
Abstract
Objective Transit time flow measurement (TTFM) can detect critical anastomotic stenosis during coronary artery bypass grafting. However, the identification of subcritical stenosis remains challenging. We hypothesized that diastolic resistance index (DRI), a novel TTFM metric, is more effective in evaluating subcritical stenosis than the currently available TTFM metrics. DRI is used to measure changes in the diastolic versus systolic resistance of distal anastomosis. Methods A total of 123 coronary bypass anastomoses in 35 patients were prospectively analyzed. During coronary artery bypass grafting, the mean graft flow (Qmean), pulsatility index, and diastolic filling were obtained. DRI was calculated using the intraoperative recordings of TTFM and arterial pressure. Postoperatively, stenosis of anastomoses was categorized into successful (<50%), subcritical (50%-74%), and critical (≥75%) via multidetector computed tomography scan. Results In total, 93 (76%), 13 (10%), and 17 (14%) anastomoses were graded as successful, subcritical, and critical, respectively. DRI and diastolic filling could distinguish subcritical from successful anastomoses (P < .01 and < .01, respectively), whereas Qmean and pulsatility index could not (P = .12 and .39, respectively). The receiver operating characteristic curves were established to evaluate the diagnostic ability for detecting ≥50% stenosis. In left anterior descending artery grafting (n = 55), DRI had the highest area under the curve (0.91), followed by diastolic filling (0.87), Qmean (0.74), and pulsatility index (0.65). Conclusions DRI and diastolic filling had a reliable diagnostic ability for detecting ≥50% stenosis during coronary artery bypass grafting. In left anterior descending artery grafting, DRI had a more satisfactory detection capability than other TTFM metrics.
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Key Words
- AUC, area under the curve
- CABG, coronary artery bypass grafting
- CCT, coronary computed tomography
- DF, diastolic filling
- DRI, diastolic resistance index
- FFR, fractional flow reserve
- ITA, internal thoracic artery
- LAD, left anterior descending artery
- LCx, left circumflex artery
- PBS, posterior balanced sensitivity
- PI, pulsatility index
- Qmean, mean graft flow
- RCA, right coronary artery
- ROC, receiver operator characteristic
- SVG, saphenous vein graft
- TTFM, transit-time flow measurement
- anastomotic stenosis
- coronary artery bypass grafting
- intraoperative graft evaluation
- transit-time flow measurement
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Affiliation(s)
- Kenichiro Takahashi
- Address for reprints: Kenichiro Takahashi, MD, PhD, Department of Cardiovascular Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
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13
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Gharleghi R, Chen N, Sowmya A, Beier S. Towards automated coronary artery segmentation: A systematic review. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 225:107015. [PMID: 35914439 DOI: 10.1016/j.cmpb.2022.107015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 07/03/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Vessel segmentation is the first processing stage of 3D medical images for both clinical and research use. Current segmentation methods are tedious and time consuming, requiring significant manual correction and hence are infeasible to use in large data sets. METHODS Here, we review and analyse available coronary artery segmentation methods, focusing on fully automated methods capable of handling the rapidly growing medical images available. All manuscripts published since 2010 are systematically reviewed, categorised into different groups based on the approach taken, and characteristics of the different approaches as well as trends over the past decade are explored. RESULTS The manuscripts were divided intro three broad categories, consisting of region growing, voxelwise prediction and partitioning approaches. The most common approach overall was region growing, particularly using active contour models, however these have had a sharp fall in popularity in recent years with convolutional neural networks becoming significantly more popular. CONCLUSIONS The systematic review of current coronary artery segmentation methods shows interesting trends, with rising popularity of machine learning methods, a focus on efficient methods, and falling popularity of computationally expensive processing steps such as vesselness and multiplanar reformation.
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Affiliation(s)
- Ramtin Gharleghi
- School of Mechanical and Manufacturing Engineering, UNSW, Sydney NSW 2053, Australia.
| | - Nanway Chen
- School of Mechanical and Manufacturing Engineering, UNSW, Sydney NSW 2053, Australia
| | - Arcot Sowmya
- School of Computer Science and Engineering, UNSW, Sydney NSW 2053, Australia; Tyree Foundation Institute of Health Engineering (Tyree IHealthE), Sydney, Australia
| | - Susann Beier
- School of Mechanical and Manufacturing Engineering, UNSW, Sydney NSW 2053, Australia
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14
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Dowling C, Nelson AJ, Lim RY, Zhang JM, Cheng K, Smith JA, Seneviratne S, Malaiapan Y, Zaman S, Wong DTL. Quantitative flow ratio to predict long-term coronary artery bypass graft patency in patients with left main coronary artery disease. Int J Cardiovasc Imaging 2022; 38:2811-2818. [DOI: 10.1007/s10554-022-02699-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 07/20/2022] [Indexed: 11/24/2022]
Abstract
Abstract
Purpose
Fractional flow reserve (FFR) has been demonstrated in some studies to predict long-term coronary artery bypass graft (CABG) patency. Quantitative flow ratio (QFR) is an emerging technology which may predict FFR. In this study, we hypothesised that QFR would predict long-term CABG patency and that QFR would offer superior diagnostic performance to quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS).
Methods
A prospective study was performed on patients with left main coronary artery disease who were undergoing CABG. QFR, QCA and IVUS assessment was performed. Follow-up computed tomography coronary angiography and invasive coronary angiography was undertaken to assess graft patency.
Results
A total of 22 patients, comprising of 65 vessels were included in the analysis. At a median follow-up of 3.6 years post CABG (interquartile range, 2.3 to 4.8 years), 12 grafts (18.4%) were occluded. QFR was not statistically significantly higher in occluded grafts (0.81 ± 0.19 vs. 0.69 ± 0.21; P = 0.08). QFR demonstrated a discriminatory power to predict graft occlusion (area under the receiver operating characteristic curve, 0.70; 95% confidence interval [CI], 0.52 to 0.88; P = 0.03). At long-term follow-up, the risk of graft occlusion was higher in vessels with a QFR > 0.80 (58.6% vs. 17.0%; hazard ratio, 3.89; 95% CI, 1.05 to 14.42; P = 0.03 by log-rank test). QCA (minimum lumen diameter, lesion length, diameter stenosis) and IVUS (minimum lumen area, minimum lumen diameter, diameter stenosis) parameters were not predictive of long-term graft patency.
Conclusions
QFR may predict long-term graft patency in patients undergoing CABG.
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15
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Carrabba N, Pontone G, Andreini D, Buffa V, Cademartiri F, Carbone I, Clemente A, Guaricci AI, Guglielmo M, Indolfi C, La Grutta L, Ligabue G, Liguori C, Mercuro G, Mushtaq S, Neglia D, Palmisano A, Sciagrà R, Seitun S, Vignale D, Francone M, Esposito A. Appropriateness criteria for the use of cardiac computed tomography, SIC-SIRM part 2: acute chest pain evaluation; stent and coronary artery bypass graft patency evaluation; planning of coronary revascularization and transcatheter valve procedures; cardiomyopathies, electrophysiological applications, cardiac masses, cardio-oncology and pericardial diseases evaluation. J Cardiovasc Med (Hagerstown) 2022; 23:290-303. [PMID: 35486680 DOI: 10.2459/jcm.0000000000001303] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In the past 20 years, cardiac computed tomography (CCT) has become a pivotal technique for the noninvasive diagnostic workup of coronary and cardiac diseases. Continuous technical and methodological improvements, combined with fast growing scientific evidence, have progressively expanded the clinical role of CCT. Randomized clinical trials documented the value of CCT in increasing the cost-effectiveness of the management of patients with acute chest pain presenting in the emergency department, also during the pandemic. Beyond the evaluation of stents and surgical graft patency, the anatomical and functional coronary imaging have the potential to guide treatment decision-making and planning for complex left main and three-vessel coronary disease. Furthermore, there has been an increasing demand to use CCT for preinterventional planning in minimally invasive procedures, such as transcatheter valve implantation and mitral valve repair. Yet, the use of CCT as a roadmap for tailored electrophysiological procedures has gained increasing importance to assure maximum success. In the meantime, innovations and advanced postprocessing tools have generated new potential applications of CCT from the simple coronary anatomy to the complete assessment of structural, functional and pathophysiological biomarkers of cardiac disease. In this complex and revolutionary scenario, it is urgently needed to provide an updated guide for the appropriate use of CCT in different clinical settings. This manuscript, endorsed by the Italian Society of Cardiology (SIC) and the Italian Society of Medical and Interventional Radiology (SIRM), represents the second of two consensus documents collecting the expert opinion of cardiologists and radiologists about current appropriate use of CCT.
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Affiliation(s)
- Nazario Carrabba
- Department of Cardiothoracovascular Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence
| | | | - Daniele Andreini
- Centro Cardiologico Monzino IRCCS.,Department of Clinical Sciences and Community Health, University of Milan, Milan
| | - Vitaliano Buffa
- Department of Radiology, Azienda Ospedaliera San Camillo Forlanini, Rome
| | | | - Iacopo Carbone
- Department of Radiological, Oncological and Pathological Sciences, 'Sapienza' University of Rome, Rome
| | - Alberto Clemente
- Department of Radiology, CNR (National Council of Research)/Tuscany Region 'Gabriele Monasterio' Foundation (FTGM), Massa
| | - Andrea Igoren Guaricci
- University Cardiology Unit, Cardiothoracic Department, Policlinic University Hospital, Bari
| | | | - Ciro Indolfi
- Department of Medical and Surgical Sciences, Magna Grecia University, Catanzaro
| | - Ludovico La Grutta
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties-ProMISE, University of Palermo
| | - Guido Ligabue
- Department of Medical and Surgical Sciences, Modena and Raggio Emilia University.,Radiology Department, AOU of Modena, Modena
| | - Carlo Liguori
- Radiology Unit, Ospedale del Mare -A.S.L Na1- Centro, Naples
| | - Giuseppe Mercuro
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari
| | | | - Danilo Neglia
- Cardiovascular Department, CNR (National Council of Research)/Tuscany Region 'Gabriele Monasterio' Foundation (FTGM), Pisa
| | - Anna Palmisano
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS Ospedale San Raffaele.,Vita-Salute San Raffaele University, Milan
| | - Roberto Sciagrà
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence
| | - Sara Seitun
- Radiology Department, Ospedale Policlinico San Martino, IRCCS Per L'Oncologia e le Neuroscienze, Genoa, Italy
| | - Davide Vignale
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS Ospedale San Raffaele.,Vita-Salute San Raffaele University, Milan
| | - Marco Francone
- Department of Radiological, Oncological and Pathological Sciences, 'Sapienza' University of Rome, Rome
| | - Antonio Esposito
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS Ospedale San Raffaele.,Vita-Salute San Raffaele University, Milan
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16
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Ma S, Zhou K, Ma Y, Ma Q, Hou Y. Coronary CTA Would Facilitate Invasive Angiography in Patients With Acute Coronary Syndrome and Coronary Bypass Grafting History. Front Cardiovasc Med 2022; 9:751527. [PMID: 35425815 PMCID: PMC9001953 DOI: 10.3389/fcvm.2022.751527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe uncertainties of grafts’ ostium and patency would cause prolonged procedure/fluoroscopy time and extra contrast agent consumption of the invasive coronary angiography (ICA) in patients with coronary artery bypass grafting (CABG) history. This study was conducted to evaluate whether the identification of grafts’ ostium and patency by coronary computed tomographic angiography (CTA) could facilitate ICA procedure.MethodsPatients with acute coronary syndrome (ACS) and CABG history who underwent ICA during hospitalization were enrolled. The patients were divided into the CTA–ICA group and the direct ICA group according to whether a coronary CTA was performed before ICA. The complete direct ICA was defined by successful selective angiography of all recorded grafts. The procedure/fluoroscopy time and contrast agent consumption of ICA were compared.ResultsThere were 14 patients in the CTA–ICA group and 24 patients in the direct ICA group. In the direct ICA group, twelve cases were conducted complete ICA. The CTA–ICA group had reduced procedure time (17.8 ± 7.1 vs. 25.9 ± 15.4 min, p = 0.03) and fluoroscopy time (fluor-time; 4.6 ± 2.3 vs. 9.8 ± 5.3 min, p < 0.01), and less contrast agent consumption (30.4 ± 5.6 vs. 49.8 ± 20.9 ml, p < 0.01) than the direct ICA group. In a subgroup analysis, the incomplete direct ICA had the longest procedure time (32.8 ± 16.5 min) or fluor-time (12.0 ± 5.5 min) and the most contrast agent consumption (58.3 ± 25.8 ml), whereas the difference between CTA–ICA and complete direct ICA groups was non-significant.ConclusionThe CTA would facilitate invasive angiography in patients with CABG by reducing procedure/fluoroscopy time and contrast agent consumption.
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Affiliation(s)
- Shaowei Ma
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ke Zhou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
- Department of Cardiac Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yue Ma
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Quanmei Ma
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Yang Hou,
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Pontone G, Rossi A, Guglielmo M, Dweck MR, Gaemperli O, Nieman K, Pugliese F, Maurovich-Horvat P, Gimelli A, Cosyns B, Achenbach S. Clinical applications of cardiac computed tomography: a consensus paper of the European Association of Cardiovascular Imaging-part I. Eur Heart J Cardiovasc Imaging 2022; 23:299-314. [PMID: 35076061 PMCID: PMC8863074 DOI: 10.1093/ehjci/jeab293] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/14/2021] [Indexed: 01/26/2023] Open
Abstract
Cardiac computed tomography (CT) was introduced in the late 1990's. Since then, an increasing body of evidence on its clinical applications has rapidly emerged. From an initial emphasis on its technical efficiency and diagnostic accuracy, research around cardiac CT has now evolved towards outcomes-based studies that provide information on prognosis, safety, and cost. Thanks to the strong and compelling data generated by large, randomized control trials, the scientific societies have endorsed cardiac CT as pivotal diagnostic test for the management of appropriately selected patients with acute and chronic coronary syndrome. This consensus document endorsed by the European Association of Cardiovascular Imaging is divided into two parts and aims to provide a summary of the current evidence and to give updated indications on the appropriate use of cardiac CT in different clinical scenarios. This first part focuses on the most established applications of cardiac CT from primary prevention in asymptomatic patients, to the evaluation of patients with chronic coronary syndrome, acute chest pain, and previous coronary revascularization.
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Affiliation(s)
- Gianluca Pontone
- Centro Cardiologico Monzino IRCCS, Via C. Parea 4, 20138 Milan, Italy
| | - Alexia Rossi
- Department of Nuclear Medicine, University Hospital, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Marco Guglielmo
- Centro Cardiologico Monzino IRCCS, Via C. Parea 4, 20138 Milan, Italy
| | - Marc R Dweck
- Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Koen Nieman
- Department of Radiology and Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Francesca Pugliese
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Pal Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Alessia Gimelli
- Fondazione CNR/Regione Toscana “Gabriele Monasterio”, Pisa, Italy
| | - Bernard Cosyns
- Department of Cardiology, CHVZ (Centrum voor Hart en Vaatziekten), ICMI (In Vivo Cellular and Molecular Imaging) Laboratory, Universitair ziekenhuis Brussel, Brussel, Belgium
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University of Erlangen, Erlangen, Germany
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18
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Zhou Z, Fu G, Feng K, Huang S, Chen G, Liang M, Wu Z. Randomized evidence on graft patency after off-pump versus on-pump coronary artery bypass grafting: An updated meta-analysis. Int J Surg 2022; 98:106212. [PMID: 35041977 DOI: 10.1016/j.ijsu.2021.106212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The debate between off-pump CABG (OPCAB) and on-pump CABG (ONCAB) has been ongoing for decades. We aimed to provide a comprehensive update of the current randomized controlled trials (RCTs) in evaluating the graft patency of OPCAB versus ONCAB. MATERIALS AND METHODS A literature search was conducted in PubMed, EMBASE, and the Cochrane Library databases until April 30, 2021. All RCTs from 2003 to 2020 comparing the results of graft patency between OPCAB and ONCAB were included. We compared the overall graft occlusion between the two groups, and subgroup analyses were conducted based on different types of conduits and target territories, crossover from off-pump to on-pump rate, and the length of follow-up. RESULTS Sixteen RCTs were identified, with 5743 grafts in the OPCAB group and 5898 in the ONCAB group. OPCAB was associated with a higher risk of occlusion in the overall graft (RR: 1.31; 95% CI, 1.17-1.46), saphenous vein graft (SVG) (RR: 1.40; 95% CI, 1.23-1.59), grafts to left anterior descending (LAD) territory (RR: 1.52; 95% CI, 1.11-2.08) and left circumflex artery (LCX) territory (RR: 1.45; 95% CI, 1.19-1.76), while no significant difference was observed between the two groups in respect of arterial conduits and grafts to right coronary artery (RCA) territory. Furthermore, the lower crossover rate and longer length of follow-up appeared to reduce the association between OPCAB and lower graft patency. CONCLUSIONS The current meta-analysis indicates that, compared with ONCAB, graft patency is poorer with OPCAB for overall grafts, SVG grafts, grafts to LAD and LCX territories, whereas the results remain comparable for arterial conduits and grafts to RCA territory.
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Affiliation(s)
- Zhuoming Zhou
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
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Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Cardiovasc Comput Tomogr 2022; 16:54-122. [PMID: 34955448 DOI: 10.1016/j.jcct.2021.11.009] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM This clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients. METHODS A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing randomized and nonrandomized trials, observational studies, registries, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. STRUCTURE Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. This guideline presents an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated, and shared decision-making with patients is recommended.
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20
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Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 78:e187-e285. [PMID: 34756653 DOI: 10.1016/j.jacc.2021.07.053] [Citation(s) in RCA: 319] [Impact Index Per Article: 106.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIM This clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients. METHODS A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing randomized and nonrandomized trials, observational studies, registries, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. STRUCTURE Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. This guideline presents an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated, and shared decision-making with patients is recommended.
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21
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2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 78:2218-2261. [PMID: 34756652 DOI: 10.1016/j.jacc.2021.07.052] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM This executive summary of the clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients. METHODS A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. STRUCTURE Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. These guidelines present an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated and shared decision-making with patients is recommended.
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Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 144:e368-e454. [PMID: 34709879 DOI: 10.1161/cir.0000000000001029] [Citation(s) in RCA: 161] [Impact Index Per Article: 53.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIM This clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients. METHODS A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing randomized and nonrandomized trials, observational studies, registries, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. Structure: Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. This guideline presents an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated, and shared decision-making with patients is recommended.
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Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 144:e368-e454. [PMID: 34709928 DOI: 10.1161/cir.0000000000001030] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM This executive summary of the clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients. METHODS A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. Structure: Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. These guidelines present an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated and shared decision-making with patients is recommended.
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24
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Chavarria J, Sibbald M, Velianou J, Natarajan M, Jaffer I, Smith A, Sheth T. A Computed Tomography Protocol to Evaluate Coronary Artery Disease Before Transcatheter Aortic Valve Replacement. Can J Cardiol 2021; 38:23-30. [PMID: 34688851 DOI: 10.1016/j.cjca.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/19/2021] [Accepted: 10/11/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) computed tomographic angiography (CTA) images can be used to evaluate coronary artery disease (CAD). METHODS We conducted a prospective cohort study of consecutive TAVR patients from November 2019 to February 2021 to evaluate TAVR CTA assessment of CAD on the rate of pre-TAVR invasive angiography. Patients had CTA first or invasive angiography first at the discretion of their treating physicians. TAVR CTA scans were categorised as normal/mild CAD, single-vessel disease, high risk (multivessel or left main disease), or nondiagnostic in patients without previous coronary artery bypass grafting (CABG) and as low risk or high risk in patients with previous CABG. Invasive angiography was recommended before TAVR for high-risk or nondiagnostic CTA findings. RESULTS TAVR was performed on 354 patients; CTA first was performed in 273 and invasive angiography first in 81. Among 231 patients without previous CABG who had CTA first, 22.1% (51/231) had pre-TAVR invasive angiography and 1.3% (3/231) had pre-TAVR revascularisation. Normal/mild CAD or single-vessel disease was found on CTA in 174 patients, of whom 0.5% (1/174) had high-risk disease on invasive angiography. Among 42 patients with previous CABG who had CTA first, 14.3% (6/42) had pre-TAVR invasive angiography and 2.4% (1/42) had pre-TAVR revascularisation. CONCLUSION TAVR CTA CAD evaluation can avoid pre-TAVR invasive angiography in more than 70% of patients while rarely missing high risk findings. A CTA-first strategy to assess CAD should be considered, especially among patients where conservative management of CAD is preferred.
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Affiliation(s)
- Jorge Chavarria
- McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Matt Sibbald
- McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - James Velianou
- McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Madhu Natarajan
- McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada
| | - Iqbal Jaffer
- McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Amanda Smith
- McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Tej Sheth
- McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada
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Pasha AK, Lee JZ, Poston RS, Abidov A. Coronary computed tomography angiography following robotic coronary artery bypass grafting surgery: Systematic approach to image analysis and practical considerations. Ann Med Surg (Lond) 2021; 67:102507. [PMID: 34276979 PMCID: PMC8271112 DOI: 10.1016/j.amsu.2021.102507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 06/17/2021] [Indexed: 11/12/2022] Open
Abstract
Standard open chest Coronary Artery Bypass Grafting (CABG) has evolved over last couple of decades. With advancement in minimally invasive procedures, Robotic CABG (RCABG) is still in its evolution phase. There is dearth of experienced surgeons in this complicated field and lack of data to verify it clinical safety. in this review, we intend to describe the utility of Cardiac Computed Tomography Angiography (CCTA) in assessment of graft anatomy and quality, grafting strategy, distal graft anastomosis site evaluation and detection of complications associated with RCABG. CCTA appears to provide valuable information regarding the visualization of grafts, target coronary arteries and other cardiac and non-cardiac structures.
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Affiliation(s)
| | | | - Robert S Poston
- Division of Cardiothoracic Surgery, SUNY Down State Medical Center, NY, USA
| | - Aiden Abidov
- Department of Medicine/Section of Cardiology, John D. Dingell VA Medical Center and Wayne State University, Detroit, MI, USA
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26
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Coronary Computer Tomography Angiography in 2021-Acquisition Protocols, Tips and Tricks and Heading beyond the Possible. Diagnostics (Basel) 2021; 11:diagnostics11061072. [PMID: 34200866 PMCID: PMC8230532 DOI: 10.3390/diagnostics11061072] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/06/2021] [Accepted: 06/09/2021] [Indexed: 01/09/2023] Open
Abstract
Recent technological advances, together with an increasing body of evidence from randomized trials, have placed coronary computer tomography angiography (CCTA) in the center of the diagnostic workup of patients with coronary artery disease. The method was proven reliable in the diagnosis of relevant coronary artery stenosis. Furthermore, it can identify different stages of the atherosclerotic process, including early atherosclerotic changes of the coronary vessel wall, a quality not met by other non-invasive tests. In addition, newer computational software can measure the hemodynamic relevance (fractional flow reserve) of a certain stenosis. In addition, if required, information related to cardiac and valvular function can be provided with specific protocols. Importantly, recent trials have highlighted the prognostic relevance of CCTA in patients with coronary artery disease, which helped establishing CCTA as the first-line method for the diagnostic work-up of such patients in current guidelines. All this can be gathered in one relatively fast examination with minimal discomfort for the patient and, with newer machines, with very low radiation exposure. Herein, we provide an overview of the current technical aspects, indications, pitfalls, and new horizons with CCTA, providing examples from our own clinical practice.
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27
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Qiao E, Wang Y, Yu J, Wang X, Luo X, Wang W. Short-term assessment of radial artery grafts with multidetector computed tomography. J Cardiothorac Surg 2021; 16:93. [PMID: 33865411 PMCID: PMC8052742 DOI: 10.1186/s13019-021-01465-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 04/05/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The clinical use of the radial artery (RA) in coronary artery bypass grafting (CABG) is still limited worldwide, although it has been recommended by several guidelines. Multidetector computed tomography (MDCT) is widely used to evaluate graft patency, as invasive coronary angiography could cause potentially serious risks including bleeding, dissection and stroke. This study aims to report the short-term results of the RA in CABG with MDCT. METHODS The study population consists of 41 consecutive patients undergoing elective CABG with the RA graft between 2017 to 2018, with MDCT performed to evaluate graft patency during follow-up, and target vessels for the RA were non-left anterior descending coronary arteries with > 70% stenosis. RESULTS A total of 150 grafts were assessed by MDCT during follow-up (mean, 8.9 ± 5.1 months). MDCT could clearly show the structure and patency of grafts, even for complex coronary artery revascularization. Graft patency of the left internal mammary artery was 92.9% (39/42), with the RA patency of 84.4% (38/45) and the patency of the saphenous vein graft of 81.1% (30/37). And the RA anastomosed to the left coronary artery system might have better patency than the RA anastomosed to the right coronary artery system (25/29, 86.2% vs 13/16, 81.3%, p = 0.686). CONCLUSIONS The short-term patency rate of RA grafts is good, and the RA might be associated with better patency when anastomosed to the left but not the right coronary artery. MDCT could provide excellent visualization of grafts in CABG.
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Affiliation(s)
- En Qiao
- Structural Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Yuetang Wang
- Structural Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Jun Yu
- Structural Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Xu Wang
- Structural Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Xinjin Luo
- Structural Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Wei Wang
- Structural Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China.
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Rahman MS, de Winter R, Nap A, Knaapen P. Advances in the Post-coronary Artery Bypass Graft Management of Occlusive Coronary Artery Disease. Interv Cardiol 2021; 16:e33. [PMID: 35106069 PMCID: PMC8785096 DOI: 10.15420/icr.2021.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/07/2021] [Indexed: 11/04/2022] Open
Abstract
Revascularisation of chronic total occlusion (CTO) represents one of the most challenging aspects of percutaneous coronary intervention, but advances in equipment and an understanding of CTO revascularisation techniques have resulted in considerable improvements in success rates. In patients with prior coronary artery bypass grafting (CABG) surgery, additional challenges are encountered. This article specifically explores these challenges, as well as antegrade methods of CTO crossing. Techniques, equipment that can be used and reference texts are highlighted with the aim of providing potential CTO operators adequate information to tackle additional complexities likely to be encountered in this cohort of patients. This review forms part of a wider series where additional aspects of patients with prior CABG should be factored into decisions and methods of revascularisation.
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Affiliation(s)
| | - Ruben de Winter
- Department of Cardiology, Amsterdam Medical Centre, VU Medical CentreAmsterdam, the Netherlands
| | - Alex Nap
- Department of Cardiology, Amsterdam Medical Centre, VU Medical CentreAmsterdam, the Netherlands
| | - Paul Knaapen
- Department of Cardiology, Amsterdam Medical Centre, VU Medical CentreAmsterdam, the Netherlands
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Chepurnenko SA, Nasytko AD, Shavkuta GV, Kostenko VL. Results of Computed Tomographic Coronary Angiography in Comparison with the Table of Pretest Probability of Chronic Coronary Syndrome. ACTA ACUST UNITED AC 2021; 61:30-35. [PMID: 33849416 DOI: 10.18087/cardio.2021.3.n1267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 12/28/2020] [Indexed: 11/18/2022]
Abstract
Aim To compare results of computed tomography coronary angiography (CTCA) with a table of pretest probability of chronic coronary syndrome (CCS) taking into account the following key variants: abnormality, microvascular damage, nonobstructive or obstructive atherosclerotic damage.Material and methods 50 patients (39 men, 20 women) aged 30 to 67 years were evaluated with a computed tomography scanner PHILIPS Brilliance iCT SP 128. A high pretest probability of ischemic heart disease was found in 44 % of cases and medium in 40%.Results According to CCS data, coronary artery (CA) pathology was not found in 28 % of patients. CA hypoplasia was observed in 4 % of patients. 22 % of patients had muscular bridges narrowing the CA lumen during systole by 40-50%. In 26 % of cases, CA had minimal and early stenoses. Moderate and pronounced stenoses were observed in 20% of cases. In one case, there was a total occlusion of the circumflex branch. Calcinates were found in 9.1 % of patients with muscular bridges, in 61.5 % of patients with minimal and early stenoses, and in 80% of patients with moderate and pronounced stenoses. In the group with "clean" CA and congenital defects, calcinates were absent. The mean value of pretest probability was the highest in the patient group with moderate and pronounced stenoses, 22.5±13.13. It was significantly higher than in the group with muscular bridges (р=0.045) and congenital pathology of CA (р=0.01). At the same time, this value did not significantly differ from the group with "clean" CA and the group with minimal and early stenoses. Based on the study results, 2 bypass surgeries and 5 CA stentings were performed.Conclusion Thus, the table of pretest probability of ischemic heart disease does not provide a differential diagnosis and evaluation of the nature of CA damage as compared to results of CTCA.
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Affiliation(s)
- S A Chepurnenko
- Rostov Regional Clinical Hospital, Rostov-na-Donu; Rostov State Medical University, Rostov-na-Donu
| | - A D Nasytko
- Rostov State Medical University, Rostov-na-Donu
| | | | - V L Kostenko
- Rostov Regional Clinical Hospital, Rostov-na-Donu
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30
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Yamagishi M, Tamaki N, Akasaka T, Ikeda T, Ueshima K, Uemura S, Otsuji Y, Kihara Y, Kimura K, Kimura T, Kusama Y, Kumita S, Sakuma H, Jinzaki M, Daida H, Takeishi Y, Tada H, Chikamori T, Tsujita K, Teraoka K, Nakajima K, Nakata T, Nakatani S, Nogami A, Node K, Nohara A, Hirayama A, Funabashi N, Miura M, Mochizuki T, Yokoi H, Yoshioka K, Watanabe M, Asanuma T, Ishikawa Y, Ohara T, Kaikita K, Kasai T, Kato E, Kamiyama H, Kawashiri M, Kiso K, Kitagawa K, Kido T, Kinoshita T, Kiriyama T, Kume T, Kurata A, Kurisu S, Kosuge M, Kodani E, Sato A, Shiono Y, Shiomi H, Taki J, Takeuchi M, Tanaka A, Tanaka N, Tanaka R, Nakahashi T, Nakahara T, Nomura A, Hashimoto A, Hayashi K, Higashi M, Hiro T, Fukamachi D, Matsuo H, Matsumoto N, Miyauchi K, Miyagawa M, Yamada Y, Yoshinaga K, Wada H, Watanabe T, Ozaki Y, Kohsaka S, Shimizu W, Yasuda S, Yoshino H. JCS 2018 Guideline on Diagnosis of Chronic Coronary Heart Diseases. Circ J 2021; 85:402-572. [PMID: 33597320 DOI: 10.1253/circj.cj-19-1131] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine Graduate School
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School
| | - Kenji Ueshima
- Center for Accessing Early Promising Treatment, Kyoto University Hospital
| | - Shiro Uemura
- Department of Cardiology, Kawasaki Medical School
| | - Yutaka Otsuji
- Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School
| | | | | | - Hajime Sakuma
- Department of Radiology, Mie University Graduate School
| | | | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, University of Fukui
| | | | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | | | - Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Kanazawa Universtiy
| | | | - Satoshi Nakatani
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School of Medicine
| | | | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Atsushi Nohara
- Division of Clinical Genetics, Ishikawa Prefectural Central Hospital
| | | | | | - Masaru Miura
- Department of Cardiology, Tokyo Metropolitan Children's Medical Center
| | | | | | | | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University
| | - Toshihiko Asanuma
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School
| | - Yuichi Ishikawa
- Department of Pediatric Cardiology, Fukuoka Children's Hospital
| | - Takahiro Ohara
- Division of Community Medicine, Tohoku Medical and Pharmaceutical University
| | - Koichi Kaikita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Tokuo Kasai
- Department of Cardiology, Uonuma Kinen Hospital
| | - Eri Kato
- Department of Cardiovascular Medicine, Department of Clinical Laboratory, Kyoto University Hospital
| | | | - Masaaki Kawashiri
- Department of Cardiovascular and Internal Medicine, Kanazawa University
| | - Keisuke Kiso
- Department of Diagnostic Radiology, Tohoku University Hospital
| | - Kakuya Kitagawa
- Department of Advanced Diagnostic Imaging, Mie University Graduate School
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School
| | | | | | | | - Akira Kurata
- Department of Radiology, Ehime University Graduate School
| | - Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
| | - Eitaro Kodani
- Department of Internal Medicine and Cardiology, Nippon Medical School Tama Nagayama Hospital
| | - Akira Sato
- Department of Cardiology, University of Tsukuba
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School
| | - Junichi Taki
- Department of Nuclear Medicine, Kanazawa University
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of the University of Occupational and Environmental Health, Japan
| | | | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | - Ryoichi Tanaka
- Department of Reconstructive Oral and Maxillofacial Surgery, Iwate Medical University
| | | | | | - Akihiro Nomura
- Innovative Clinical Research Center, Kanazawa University Hospital
| | - Akiyoshi Hashimoto
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University
| | - Kenshi Hayashi
- Department of Cardiovascular Medicine, Kanazawa University Hospital
| | - Masahiro Higashi
- Department of Radiology, National Hospital Organization Osaka National Hospital
| | - Takafumi Hiro
- Division of Cardiology, Department of Medicine, Nihon University
| | | | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center
| | - Naoya Matsumoto
- Division of Cardiology, Department of Medicine, Nihon University
| | | | | | | | - Keiichiro Yoshinaga
- Department of Diagnostic and Therapeutic Nuclear Medicine, Molecular Imaging at the National Institute of Radiological Sciences
| | - Hideki Wada
- Department of Cardiology, Juntendo University Shizuoka Hospital
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University
| | - Yukio Ozaki
- Department of Cardiology, Fujita Medical University
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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Hennessey B, Vera-Urquiza R, Mejía-Rentería H, Gonzalo N, Escaned J. Contemporary use of coronary computed tomography angiography in the planning of percutaneous coronary intervention. Int J Cardiovasc Imaging 2020; 36:2441-2459. [DOI: 10.1007/s10554-020-02052-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 09/29/2020] [Indexed: 02/06/2023]
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32
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Canan A, Ranganath P, Goerne H, Abbara S, Landeras L, Rajiah P. CAD-RADS: Pushing the Limits. Radiographics 2020; 40:629-652. [PMID: 32281902 DOI: 10.1148/rg.2020190164] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Coronary CT angiography is now established as the first-line diagnostic imaging test to exclude coronary artery disease (CAD) in the population at low to intermediate risk. Wide variability exists in both the reporting of coronary CT angiography and the interpretation of these reports by referring physicians. The CAD Reporting and Data System (CAD-RADS) is sponsored by multiple societies and is a collaborative effort to provide standard classification of CAD, which is then integrated into patient clinical care. The main goals of the CAD-RADS are to decrease variability among readers; enhance communication between interpreting and referring clinicians, allowing collaborative determination of the best course of patient care; and generate consistent data for auditing, data mining, quality improvement, research, and education. There are several scenarios in which the CAD-RADS guidelines are ambiguous or do not provide definite recommendations for further management of CAD. The authors discuss the CAD-RADS categories and modifiers, highlight a variety of complex or ambiguous scenarios, and provide recommendations for managing these scenarios. Online supplemental material is available for this article. ©RSNA, 2020 See discussion on this article by Aviram and Wolak.
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Affiliation(s)
- Arzu Canan
- From the Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Tex (A.C., P. Ranganath, H.G., S.A., P. Rajiah); Imaging and Diagnosis Center, Guadalajara, Mexico (H.G.); and Department of Radiology, University of Chicago Medical Center, Chicago, Ill (L.L.)
| | - Praveen Ranganath
- From the Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Tex (A.C., P. Ranganath, H.G., S.A., P. Rajiah); Imaging and Diagnosis Center, Guadalajara, Mexico (H.G.); and Department of Radiology, University of Chicago Medical Center, Chicago, Ill (L.L.)
| | - Harold Goerne
- From the Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Tex (A.C., P. Ranganath, H.G., S.A., P. Rajiah); Imaging and Diagnosis Center, Guadalajara, Mexico (H.G.); and Department of Radiology, University of Chicago Medical Center, Chicago, Ill (L.L.)
| | - Suhny Abbara
- From the Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Tex (A.C., P. Ranganath, H.G., S.A., P. Rajiah); Imaging and Diagnosis Center, Guadalajara, Mexico (H.G.); and Department of Radiology, University of Chicago Medical Center, Chicago, Ill (L.L.)
| | - Luis Landeras
- From the Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Tex (A.C., P. Ranganath, H.G., S.A., P. Rajiah); Imaging and Diagnosis Center, Guadalajara, Mexico (H.G.); and Department of Radiology, University of Chicago Medical Center, Chicago, Ill (L.L.)
| | - Prabhakar Rajiah
- From the Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Tex (A.C., P. Ranganath, H.G., S.A., P. Rajiah); Imaging and Diagnosis Center, Guadalajara, Mexico (H.G.); and Department of Radiology, University of Chicago Medical Center, Chicago, Ill (L.L.)
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33
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Schwarz K, Sultan A, Poole H, Jones H, Duckett S, Nolan J. Comparison of Radiation Dose and Contrast Use in CT vs. Diagnostic Invasive Angiography in Coronary Artery Bypass Graft Patients. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:927-928. [PMID: 32199793 DOI: 10.1016/j.carrev.2020.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Konstantin Schwarz
- Worcestershire Royal Hospital, United Kingdom; Royal Stoke University Hospital, University Hospitals of North Midlands, United Kingdom.
| | - Abdullah Sultan
- Royal Stoke University Hospital, University Hospitals of North Midlands, United Kingdom
| | - Harry Poole
- Royal Stoke University Hospital, University Hospitals of North Midlands, United Kingdom
| | - Hefin Jones
- Royal Stoke University Hospital, University Hospitals of North Midlands, United Kingdom
| | - Simon Duckett
- Royal Stoke University Hospital, University Hospitals of North Midlands, United Kingdom
| | - Jim Nolan
- Royal Stoke University Hospital, University Hospitals of North Midlands, United Kingdom
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Jones DA, Castle EV, Beirne AM, Rathod KS, Treibel TA, Guttmann OP, Moon JC, Smith EJ, Bourantas CV, Davies LC, Wragg A, Pugliese F, Mathur A. Computed tomography cardiac angiography for planning invasive angiographic procedures in patients with previous coronary artery bypass grafting. EUROINTERVENTION 2020; 15:e1351-e1357. [DOI: 10.4244/eij-d-18-01185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Park SJ, Kim HJ, Kim JB, Jung SH, Choo SJ, Lee JW, Chung CH. Sequential Versus Individual Saphenous Vein Grafting During Coronary Arterial Bypass Surgery. Ann Thorac Surg 2019; 109:1165-1173. [PMID: 31539513 DOI: 10.1016/j.athoracsur.2019.07.094] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 07/08/2019] [Accepted: 07/29/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although multiarterial grafting or bilateral mammary artery use is being increasingly emphasized for contemporary coronary artery bypass grafting (CABG) practice, saphenous vein graft (SVG) is still the most frequently used CABG conduit, and it accounts for 80% of all CABG conduits. Research focusing on modifiable surgical factors such as anastomosis technique, however, is scarce. This study aimed to compare clinical outcomes and graft patency according to anastomosis methods of vein grafting. METHODS From January 2005 through December 2016, patients who underwent CABG using SVG either by a sequential or an individual grafting technique were enrolled in this study. Graft patency was evaluated with coronary computed tomographic angiography. Propensity-score matching was used to compare the clinical outcomes and graft patency of these 2 grafting techniques to reduce treatment selection bias. RESULTS Overall 2515 eligible patients, 1,037 in the sequential SVG graft group (41.3%) and 1478 (58.8%) in the individual SVG graft group were enrolled. After propensity-score matching, 901 matched pairs of patients and 891 matched pairs of grafts were included in the final outcome analysis. There were no significant differences in unadjusted (P = .83) and adjusted overall mortality (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.79 to 1.17; P = .67). The composite outcome of death, nonfatal myocardial infarction, and repeat revascularization also did not significantly differ between the sequential SVG and the individual SVG groups for both before (P = .20) and after matching (HR, 0.91; 95% CI, 0.75 to 1.09; P = .30). The sequential grafts showed superior patency as compared with the individual grafts for both before (P = .015) and after adjustment (HR, 0.61; 95% CI, 0.45 to 0.82; P < .001). CONCLUSIONS The sequential grafting technique of SVG showed fairly acceptable safety and efficacy with superior long-term graft patency than individual grafts. Sequential SVG grafts perhaps can be a reasonable option as a second graft in CABG in some clinical situations.
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Affiliation(s)
- Sung Jun Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ho Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung-Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Suk Jung Choo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae Won Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Cheol Hyun Chung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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Jubran A, Willemink MJ, Nieman K. Coronary CT in Patients with a History of PCI or CABG: Helpful or Harmful? CURRENT CARDIOVASCULAR IMAGING REPORTS 2019. [DOI: 10.1007/s12410-019-9496-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Shi J, Zhang J, Yin M, Wang Q, Du J. Accurate and continuous ultrasonography evaluation of small diameter vascular prostheses in vivo. Exp Ther Med 2018; 15:3899-3907. [PMID: 29563986 PMCID: PMC5858090 DOI: 10.3892/etm.2018.5895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 01/05/2018] [Indexed: 11/24/2022] Open
Abstract
There is a large clinical requirement for novel vascular grafts; however, the development of novel vascular grafts has not been extremely successful to date. The most successful method for the continuous evaluation of vascular grafts in vivo remains unclear. Therefore, an optimal successive, non-invasive imaging modality is necessary for the study of vascular transplantation. In the present study, a common rabbit model of carotid artery defect was utilized. The patency and hemodynamic characteristics of implanted grafts was examined following surgery by color Doppler ultrasound in three modes, including B-mode, color flow map and pulse-Doppler examination. The results revealed that ultrasound had sufficient spatial resolution to generate clear images of the carotid artery of rabbits with or without the implanted grafts. Color Doppler ultrasound may be applied to evaluate and differentiate the patent, stenosis and occlusion of carotid arteries in rabbits with different vascular grafts implanted. Furthermore, color Doppler ultrasound is an optimal imaging modality for continuous evaluation in vivo. It is also possible for some quantitative analyses to be performed, including measuring the diameter of vascular lumens and the flow velocity of the region of interest. The present study suggests vascular ultrasound as the optimum choice for continuous surveillance of vascular prostheses in vivo, which may provide valuable information about the grafts in order to greatly shorten the experimental period.
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Affiliation(s)
- Jing Shi
- Imaging Diagnosis Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, P.R. China
| | - Jialing Zhang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, P.R. China
| | - Meng Yin
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, P.R. China
| | - Qian Wang
- Imaging Diagnosis Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, P.R. China
| | - Jun Du
- Imaging Diagnosis Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, P.R. China
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Abstract
Invasive coronary angiography (ICA) is the traditional method for the follow-up of graft patency in coronary artery bypass graft (CABG) patients. Nevertheless, the advent of multidetector computed tomography (MDCT) opened new perspectives for using a noninvasive, equally reliable method to study CABG patients. This review article will analyze the current feasibility of modern multi-slice MDCT, as well as its future perspectives.
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Affiliation(s)
- Davide Di Lazzaro
- Azienda Ospedaliera di Perugia "Ospedale Santa Maria della misericordia", S.C. di Cardiochirurgia Perugia, Italy
| | - Federico Crusco
- USL Umbria 2 "Nuovo Ospedale San Giovanni Battista", Radiologia, Foligno, Italy
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