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Published on: January 28, 2020
Prognostic value of CT angiography in coronary bypass patients
Benjamin J W Chow1, Osman Ahmed, Gary Small
1Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. bchow@ottawaheart.ca
Insights
Coronary computed tomography angiography (CTA) can predict major adverse cardiac events in coronary artery bypass graft (CABG) patients. The number of unprotected coronary territories (UCTs) identified by CTA provides prognostic value beyond clinical risk factors.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Cardiac Surgery
Background:
- Coronary computed tomography angiography (CTA) is established for detecting obstructive coronary artery disease.
- Prognostic value of CTA in patients without prior revascularization is known.
- The predictive capability of coronary CTA for major adverse cardiac events (MACE) in coronary artery bypass graft (CABG) patients remains unclear.
Purpose of the Study:
- To determine the incremental prognostic value of coronary CTA in patients who have undergone CABG.
- To assess if coronary CTA can improve risk stratification in this patient population.
Main Methods:
- Prospective enrollment of consecutive CABG patients.
- Calculation of unprotected coronary territories (UCTs) based on native coronary artery disease and graft status.
- Follow-up for major adverse cardiac events (cardiac death, nonfatal myocardial infarction).
Main Results:
- The number of unprotected coronary territories (UCTs) was a significant predictor of MACE in CABG patients (HR 2.08, p < 0.001).
- Absence of UCTs indicated a good prognosis (2.4% annual event rate).
- Inclusion of UCTs in multivariable models improved risk prediction (AUC increased from 0.61 to 0.76, p = 0.001).
Conclusions:
- Coronary CTA, specifically the assessment of UCTs, provides prognostic information incremental to clinical variables in CABG patients.
- Coronary CTA shows promise as a tool for risk stratification in the post-CABG population.
- Further multicenter studies with larger CABG cohorts are warranted to validate these findings.
Objectives:
We sought the incremental prognostic value of coronary computed tomography angiography (CTA) in coronary artery bypass graft (CABG) patients.
Background:
Coronary CTA is a noninvasive and accurate tool for the detection of obstructive coronary artery disease, and coronary CTA appears to have prognostic value in patients without previous revascularization. However, the prognostic value of coronary CTA to predict major adverse cardiac events in CABG patients is unclear.
Methods:
Consecutive CABG patients were prospectively enrolled and cardiac risk was calculated using the National Cholesterol Evaluation Program/Adult Treatment Panel III. Using the severity of native coronary artery disease and graft disease, the number of unprotected coronary territories (UCTs) (0, 1, 2, or 3) was calculated. Patients were followed for cardiac death and nonfatal myocardial infarction. All events were confirmed with death certificates or medical records and reviewed by a clinical events committee.
Results:
Between February 2006 and March 2009, 250 consecutive patients were enrolled and followed for a mean of 20.8 ± 10.1 months. At follow-up, 23 patients (9.2%) had major adverse cardiac events (15 cardiac deaths and 8 nonfatal MI). The absence of UCTs conferred a good prognosis with an annual event rate of 2.4%. Conversely, patients with 1, 2, and 3 UCTs had annualized event rates of 5.8%, 11.1%, and 21.7%, respectively. Multivariable analysis showed that UCTs (hazard ratio: 2.08; 95% confidence interval: 1.40 to 3.10; p < 0.001) was a predictor of major adverse cardiac events when adjusted for clinical variables. Examining the receiver-operator characteristic curves, the area under the curve increased from 0.61 to 0.76 when UCTs was combined with clinical variables (p = 0.001).
Conclusions:
Assessing UCTs with coronary CTA appears to have prognostic value in CABG patients and is incremental to clinical variables. Coronary CTA appears to be a promising tool for risk stratification of CABG patients. Further multicenter studies using large CABG cohorts are needed to confirm our findings.
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