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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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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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Jayananda AD, Patnaik S, Rao A, Rammurti S. Role of MDCT in Assessment of Long-term Graft Patency in Female Patients. INDIAN JOURNAL OF CARDIOVASCULAR DISEASE IN WOMEN 2022. [DOI: 10.25259/mm_ijcdw_475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objectives:
The aim of the study was to analyze the utility of CT-coronary angiogram (CT-CAG) in assessment of long-term graft patency compared to conventional invasive coronary angiography (ICA) and highlight any gender-specific issues in female post-coronary artery bypass surgery (CABG) patients.
Materials and Methods:
The medical records and images of 30 patients including four female patients who had CABG in the past and underwent both conventional and CT-CAGs were analyzed retrospectively.
Results:
We studied 30 patients who had CABG in whom both CT-CAG and conventional coronary angiograms were performed. CT-CAG was able to evaluate the grafts better than ICA and was useful even in those which could not be assessed due to technical failure by ICA. There were only four female patients in this series. In first patient, the arterial graft (left internal mammary artery [LIMA]) was patent but distal run off was absent in LAD in CT-CAG images and was reported as poor in conventional coronary angiogram. The second patient had CABG 10 years back. The arterial graft (LIMA) to LAD was patent and there was total block in SVG graft to RCA at proximal anastomotic site. The third patient with hypertension and diabetes also had CABG 10 years back. Both LIMA to LAD and SVG to PDA were patent in her. In last case who had CABG 7 years, two of the three SVG grafts were blocked which were well-demonstrated on CT CAG, including one SVG missed on conventional CAG.
Conclusion:
CT-CAG is a non-invasive and less cumbersome alternative to conventional CAG for the assessment of grafts long after CABG even in women. The data generated by CT-CAG in post-CABG are as good as the invasive CAG and it has distinct advantage of greater acceptability.
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Affiliation(s)
- Amin Dhanush Jayananda
- Department of Radiology and Imageology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India,
| | - Sujata Patnaik
- Department of Radiology and Imageology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India,
| | - Amaresh Rao
- Department of Radiology and Imageology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India,
| | - S. Rammurti
- Department of Radiology and Imageology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India,
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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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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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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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Barbero U, Iannaccone M, d'Ascenzo F, Barbero C, Mohamed A, Annone U, Benedetto S, Celentani D, Gagliardi M, Moretti C, Gaita F. 64 slice-coronary computed tomography sensitivity and specificity in the evaluation of coronary artery bypass graft stenosis: A meta-analysis. Int J Cardiol 2016; 216:52-7. [DOI: 10.1016/j.ijcard.2016.04.156] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 03/29/2016] [Accepted: 04/20/2016] [Indexed: 11/26/2022]
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Chan M, Ridley L, Dunn DJ, Tian DH, Liou K, Ozdirik J, Cheruvu C, Cao C. A systematic review and meta-analysis of multidetector computed tomography in the assessment of coronary artery bypass grafts. Int J Cardiol 2016; 221:898-905. [PMID: 27439070 DOI: 10.1016/j.ijcard.2016.06.264] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 06/04/2016] [Accepted: 06/27/2016] [Indexed: 02/08/2023]
Abstract
PURPOSE The present meta-analysis aimed to compare the diagnostic accuracy of more recent computed tomography coronary angiography (CTCA) with invasive coronary angiography (ICA) in the assessment of graft patency after coronary artery bypass graft surgery (CABG). MATERIAL AND METHODS A systematic review was performed using nine electronic databases from their dates of inception to July 2015. Predefined inclusion criteria included studies reporting on comparative outcomes using ≥64 slice multidetector computed tomography (MDCT) and ICA. The primary endpoints included graft occlusion and significant graft stenosis ≥50%. Secondary analyses included the comparison of arterial versus venous graft conduits, and the use of different MDCT techniques. RESULTS Thirty-one studies were identified according to selection criteria, involving 1975 patients with 5364 assessed grafts. Combined assessment of stenosis and occlusion for all grafts demonstrated a sensitivity of 96.1% [95% confidence interval (CI) 94.3-97.4%] and specificity of 96.3% (95% CI 95.1-97.3%). CTCA assessment of venous grafts demonstrated higher sensitivity compared to arterial grafts, when testing for both occlusion and stenosis (97.6% vs 89.2%, p=0.004). CONCLUSION Results of this study demonstrated that CTCA had a relatively high pooled sensitivity, specificity and negative predictive value compared to ICA. However, patient baseline characteristics varied between studies, and the results should be interpreted with caution. Nonetheless, our results indicate that CTCA should be recognized as an accurate and non-invasive investigation for graft patency in symptomatic patients after CABG.
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Affiliation(s)
- Michael Chan
- Department of Radiology, Concord Repatriation and General Hospital, Sydney, Australia
| | - Lloyd Ridley
- Department of Radiology, Concord Repatriation and General Hospital, Sydney, Australia
| | | | - David H Tian
- The Collaborative Research Group, Macquarie University, Sydney, Australia
| | - Kevin Liou
- The Collaborative Research Group, Macquarie University, Sydney, Australia
| | - Jessica Ozdirik
- The Collaborative Research Group, Macquarie University, Sydney, Australia
| | - Chaitu Cheruvu
- Department of Cardiology, Prince of Wales Hospital, Sydney, Australia
| | - Christopher Cao
- The Collaborative Research Group, Macquarie University, Sydney, Australia.
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Samano N, Geijer H, Liden M, Fremes S, Bodin L, Souza D. The no-touch saphenous vein for coronary artery bypass grafting maintains a patency, after 16 years, comparable to the left internal thoracic artery: A randomized trial. J Thorac Cardiovasc Surg 2015; 150:880-8. [DOI: 10.1016/j.jtcvs.2015.07.027] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 06/23/2015] [Accepted: 07/08/2015] [Indexed: 10/23/2022]
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