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Non-invasive evaluation of coronary artery bypass grafts using multi-slice computed tomography: initial clinical
Christof Burgstahler1, Axel Kuettner, Andreas F Kopp
1Department of Internal Medicine, Eberhard-Karls-University, Otfried-Mueller-Str 10, 72076, Tuebingen, Germany.
Insights
Multi-slice computed tomography angiography (MSCTA) shows promise for detecting significant blockages in coronary artery bypass grafts (CABG). This non-invasive imaging method achieved 86% sensitivity and 100% specificity in a small study, aiding in the assessment of graft patency.
Area of Science:
- Cardiology
- Medical Imaging
- Radiology
Background:
- Recurrent angina after coronary artery bypass graft (CABG) surgery is common.
- Non-invasive imaging of CABG using computed tomography has evolved significantly.
- Multi-slice computed tomography (MSCT) offers improved detection of coronary lesions.
Purpose of the Study:
- To evaluate the efficacy of MSCT angiography (MSCTA) in detecting stenosis or occlusion in CABG.
- To compare MSCTA findings with conventional coronary angiography for CABG assessment.
Main Methods:
- Ten male patients with prior CABG surgery underwent both conventional coronary angiography and MSCTA.
- Twenty-one bypass grafts (14 venous, 7 arterial) were analyzed.
- MSCTA analysis was performed blinded to the coronary angiography results.
Main Results:
- MSCTA successfully visualized 18 out of 21 (86%) bypass grafts.
- Significant stenosis (>75%) was detected in 7 grafts, with MSCTA identifying 6 (86% sensitivity, 75% positive predictive value).
- MSCTA demonstrated 100% specificity for grafts without severe lesions.
Conclusions:
- MSCTA is a promising non-invasive technique for detecting lesions in coronary artery bypass grafts.
- Further validation with larger patient cohorts is warranted.
- MSCTA aids in evaluating graft patency and identifying potential causes of recurrent angina.
Abstract:
Recurrence of angina pectoris in patients with previous coronary artery bypass graft (CABG) surgery due to severe coronary artery disease (CAD) is a common problem. Non-invasive imaging of coronary artery bypass grafts by computed tomography was first described in the early 1980s. Meanwhile, multi-slice computed tomography (MSCT) is now available. This new technique allows detection of coronary lesions with good sensitivity and specificity due to continuous improvement and modification of this method. The aim of this study was to investigate whether stenosis or occlusion of CABG can be detected by MSCT. Ten consecutive male patients (mean age 61+/-9.1 years) with previous CABG surgery and 21 bypass grafts (14 venous grafts, seven arterial grafts) were included in this study. Conventional coronary angiography and MSCT angiography (MSCTA) were performed in all patients. MSCTA results were compared with coronary angiography in regard of visualization and lesion detection in CABG. The analysis of MSCTA was performed blinded to the angiographic results. It was found that 18 of 21 bypass grafts (86%) were analyzable by MSCTA: seven of 21 (33%) grafts showed a significant stenosis (>75%), while six of them were detected by MSCTA (sensitivity: 86%, positive predictive value: 0.75). Dissection of one arterial graft could not be evaluated by MSCTA. Twelve of 13 grafts without severe lesion showed no significant stenosis in MSCTA (negative predictive value: 0.86). All grafts without severe lesions by MSCT showed no significant lesion in X-ray angiography (specificity: 100%). MSCTA is a promising new method for the detection of lesions in coronary artery bypass grafts. However, these data based on a small number has to be reevaluated by larger studies.