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The comparison of the graft patency after coronary artery bypass grafting using coronary angiography and multi-slice
Kyung-Jong Yoo1, Donghoon Choi, Byoung Wook Choi
1Department of Thoracic and Cardiovascular Surgery, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea. kjy@yumc.yonsei.ac.kr
Insights
Multi-slice CT (m-CT) accurately assesses graft patency after coronary artery bypass grafting (CABG), showing high sensitivity and specificity. This non-invasive method offers a simple and reliable alternative to traditional coronary angiography (CAG) for early post-operative evaluation.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Cardiac Surgery
Background:
- Coronary angiography (CAG) is the standard for assessing graft patency post-coronary artery bypass grafting (CABG).
- Non-invasive imaging methods are sought to complement or replace CAG.
- Multi-slice CT (m-CT) offers rapid cardiac imaging capabilities.
Purpose of the Study:
- To compare the diagnostic accuracy of multi-slice CT (m-CT) with coronary angiography (CAG) for evaluating graft patency after CABG.
- To assess the efficacy of m-CT in the early post-operative period.
Main Methods:
- A study involving 42 patients who underwent both m-CT and CAG within 3 months of CABG.
- Analysis of 125 grafts, including left internal mammary arteries (LIMA), radial arteries (RA), right internal mammary arteries (RIMA), and vein grafts.
- Comparison of graft patency rates between m-CT and CAG.
Main Results:
- CAG identified 96% graft patency, while m-CT showed a 98% correct positive ratio.
- m-CT demonstrated high sensitivity (98%) and specificity (100%) for overall graft patency.
- Specific sensitivities for LIMA, RA, RIMA, and vein grafts were 98%, 91%, 100%, and 100%, respectively, with 100% specificity for all graft types.
Conclusions:
- Multi-slice CT (m-CT) is a simple, useful, and accurate tool for evaluating graft patency in the early post-CABG period.
- m-CT provides high diagnostic performance comparable to CAG.
- An equivocal finding was noted for competitive grafts with native coronary arteries.
Objective:
Coronary angiography (CAG) is the gold standard method in evaluating graft patency following coronary artery bypass grafting (CABG), even though there are several kinds of non-invasive methods. Recently developed multi-slice CT (m-CT), having effective scan times up to 0.25 s and multi-row detector array systems, enable rapid imaging of cardiac structures, including coronary arteries during one breath-hold. We compared m-CT with CAG for the evaluation of graft patency following CABG.
Methods:
Forty-two patients having undergone m-CT and CAG within 3 months of CABG were studied. Twenty-three patients underwent conventional CABG and 19 off-pump CABG. A total of 125 grafts were used, including 42 left internal mammary arteries (LIMA), 25 radial arteries (RA), 3 right internal mammary arteries (RIMA) and 55 vein grafts.
Results:
CAG showed a 96% (120/125) patency rate (1 LIMA, 2 RA and 2 vein grafts were occluded). m-CT showed a 98% (122/125) correct positive ratio with a sensitivity and specificity of 98 and 100%, respectively. The sensitivity in LIMA, RA, RIMA and vein grafts was 98, 91, 100 and 100%, respectively, with 100% specificity for all. There was an equivocal result in the competitive grafts with native coronary artery that were patent in the CAG, but faint opacification with no significant flow in the m-CT.
Conclusions:
This study showed that m-CT was very simple, useful and accurate in evaluating graft patency during the early post-operative period following CABG, even though there was an equivocal result in the competitive grafts with a native coronary artery.
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