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Published on: August 28, 2018
Prognostic value of coronary CTA in coronary bypass patients: a long-term follow-up study
Saima Mushtaq1, Daniele Andreini2, Gianluca Pontone1
1Centro Cardiologico Monzino, IRCCS, Milan, Italy.
Insights
Coronary computed tomography angiography (CTA) effectively predicts long-term cardiovascular risks in coronary artery bypass graft (CABG) patients. The number of unprotected coronary territories (UCTs) is a strong independent predictor of adverse cardiovascular events.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Medical Diagnostics
Background:
- Coronary CTA demonstrates prognostic value in non-revascularized patients.
- Prognostic assessment using coronary CTA in CABG patients requires further evaluation.
Purpose of the Study:
- To assess the long-term prognostic capability of coronary CTA in a large cohort of CABG patients.
- To determine the predictive value of UCT and CAPS scores in this population.
Main Methods:
- A cohort of 711 CABG patients with evaluable coronary CTA images were analyzed.
- Patients were stratified by unprotected coronary territories (UCTs) and coronary artery protection score (CAPS).
- Primary endpoint: cardiovascular death or myocardial infarction; Secondary endpoint: composite adverse cardiovascular events.
Main Results:
- High UCT scores (2 and 3) and CAPS 4 were strong predictors of cardiovascular death/MI (HRs up to 24.1).
- Multivariable analysis confirmed UCTs as an independent predictor of CV death/MI (HRs up to 10.18).
- Survival rates significantly decreased with increasing UCT scores.
Conclusions:
- Coronary CTA is a valuable tool for long-term risk stratification in CABG patients.
- The UCT score demonstrates significant prognostic value for predicting cardiovascular death and myocardial infarction.
Objectives:
The goal of this study was to determine the long-term prognostic value of coronary computed tomography angiography (CTA) in a large coronary artery bypass graft (CABG) population.
Background:
Coronary CTA has shown prognostic utility in patients without previous revascularization. However, prognostication with coronary CTA in CABG patients has not been fully assessed.
Methods:
Between March 2005 and April 2009, 887 consecutive CABG patients (mean age 66.8 ± 8.4 years) were considered for the inclusion in the study. Patients were classified by the number of unprotected coronary territories (UCTs) and a summary of native vessel disease and graft patency: the coronary artery protection score (CAPS). A primary endpoint (cardiovascular [CV] death, nonfatal myocardial infarction [MI]) and a secondary combined adverse events endpoint (CV death, MI, unstable angina, and late revascularizations) were recorded.
Results:
Among the 887 evaluated, 166 did not meet the inclusion criteria. The final study population consisted of 721 subjects. Ten patients were excluded for unevaluable coronary CTA images. Of the remaining 711 patients, follow-up (mean 73.5 ± 14 months) was obtained in 698. Three hundred forty-seven events were recorded. By univariable analysis, the strongest coronary CTA predictors of events were UCT 2 and 3 (hazard ratio [HR] for CV death/MI: 7.5 and 10.19, p < 0.0001 and p < 0.0003, respectively) and CAPS 4 (HR for CV death/MI: 24.1, p < 0.0001). A high number of UCTs was also a strong multivariable independent predictor of CV death/MI (HR: 7.78 and 10.18 for UCT 2 and 3, p < 0.0001 and p < 0.0007, respectively). Cumulative survival rates for CV death/MI and composite adverse CV events were 86% and 73% with UCT 0, 84% and 49% with UCT 1, 53% and 3% with UCT 2, and 29% and 0% with UCT 3, respectively.
Conclusions:
Coronary CTA appears to be a promising tool for long-term risk stratification of CABG patients. The UCT score has significant prognostic value to predict CV deaths/MI.
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