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Published on: August 28, 2018
64 slice-coronary computed tomography sensitivity and specificity in the evaluation of coronary artery bypass graft
Umberto Barbero1, Mario Iannaccone1, Fabrizio d'Ascenzo1
1Cardiology Department, Città Della Salute e della Scienza Hospital, Turin, Italy.
Insights
64-slice-coronary computed tomography (CCT) offers a highly accurate, non-invasive method for evaluating coronary artery bypass graft (CABG) patency and stenosis. This technique demonstrates excellent sensitivity and specificity, providing a reliable alternative to invasive coronary angiography for patient follow-up.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Medical Diagnostics
Background:
- Coronary artery bypass graft (CABG) surgery is a common procedure for managing coronary artery disease.
- Accurate follow-up of CABG patients is crucial for detecting graft failure, including stenosis and occlusion.
- Coronary angiography, while definitive, is invasive and carries associated risks.
Purpose of the Study:
- To evaluate the diagnostic performance of 64-slice-coronary computed tomography (CCT) in assessing the patency and stenosis of coronary artery bypass grafts (CABGs).
- To compare the accuracy of 64-slice-CCT against invasive coronary angiography in CABG patients.
- To determine the sensitivity, specificity, and overall diagnostic utility of 64-slice-CCT for CABG evaluation.
Main Methods:
- A systematic review and meta-analysis of published studies comparing 64-slice-CCT with invasive coronary angiography in patients with stable symptoms and prior CABG.
- Inclusion criteria focused on studies reporting diagnostic performance metrics for CABG occlusion and stenosis (>50%).
- Meta-regression analysis was performed to assess the impact of patient age and time from graft implantation on diagnostic accuracy.
Main Results:
- 64-slice-CCT demonstrated high diagnostic accuracy for CABG occlusion, with a pooled sensitivity of 0.99 (95% CI: 0.97-1.00) and specificity of 0.99 (95% CI: 0.99-1.00), AUC 0.99.
- For detecting any CABG stenosis >50%, sensitivity was 0.98 (95% CI: 0.97-0.99) and specificity was 0.98 (95% CI: 0.96-0.98), AUC 0.99.
- Neither patient age nor time from graft implantation significantly affected the diagnostic performance of 64-slice-CCT.
Conclusions:
- 64-slice-coronary computed tomography is a highly sensitive and specific non-invasive tool for evaluating coronary artery bypass graft stenosis and occlusion.
- Its diagnostic performance is robust and not significantly influenced by patient age or time since grafting.
- 64-slice-CCT represents a valuable alternative to invasive angiography for the follow-up of CABG patients.
Abstract:
A non-invasive approach to define grafts patency and stenosis in the follow-up of coronary artery bypass graft (CABG) patients may be an interesting alternative to coronary angiography. 64-slice-coronary computed tomography is nowadays a diffused non-invasive method that permits an accurate evaluation of coronary stenosis, due to a high temporal and spatial resolution. However, its sensitivity and specificity in CABG evaluation has to be clearly defined, since published studies used different protocols and scanners. We collected all studies investigating patients with stable symptoms and previous CABG and reporting the comparison between diagnostic performances of invasive coronary angiography and 64-slice-coronary computed tomography. As a result, sensitivity and specificity of 64-slice-coronary computed tomography for CABG occlusion were 0.99 (95% CI 0.97-1.00) and 0.99 (95% CI: 0.99-1.00) with an area under the curve (AUC) of 0.99. 64-slice-coronary computed tomography sensitivity and specificity for the presence of any CABG stenosis >50% were 0.98 (95% CI: 0.97-0.99) and 0.98 (95% CI: 0.96-0.98), while AUC was 0.99. At meta-regression, neither the age nor the time from graft implantation had effect on sensitivity and specificity of 64-slice-coronary computed tomography detection of significant CABG stenosis or occlusion. In conclusion 64-slice-coronary computed tomography confirmed its high sensitivity and specificity in CABG stenosis or occlusion evaluation.
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