Coronary bypass surgery guided by computed tomography in a low-risk population

Area of Science:

• Cardiovascular Imaging
• Interventional Cardiology
• Cardiac Surgery

Background:

• Coronary artery bypass grafting (CABG) decisions for complex coronary artery disease often rely on invasive coronary angiography (ICA).
• Coronary computed tomography angiography (CCTA) offers a non-invasive alternative for assessing coronary anatomy and functionality.
• Evaluating CCTA's role in guiding CABG strategy is crucial for optimizing treatment planning.

Purpose of the Study:

• To assess the feasibility and safety of planning CABG solely based on CCTA in patients with three-vessel and/or left main coronary artery disease.
• To determine the concordance between CCTA-guided revascularization planning and decisions based on ICA.
• To evaluate the safety endpoints, including graft patency, major adverse cardiac and cerebrovascular events (MACCE), and bleeding, at 30-day follow-up.

Main Methods:

• A prospective study where CABG procedures were planned using CCTA without knowledge of ICA results.
• A central core laboratory assessed coronary anatomy and functionality from CCTA to recommend the CABG strategy.
• Primary endpoints included feasibility (percentage of operations performed without ICA access) and 30-day graft patency via follow-up CCTA.

Main Results:

• The study included 114 patients with complex coronary artery disease (mean anatomical SYNTAX score 43.6).
• Feasibility of CCTA-guided CABG was high at 99.1%, with ICA unblinding required in only one case.
• Revascularization planning showed substantial agreement between CCTA and ICA (82.9%) and CCTA and actual treatment (83.7%).
• 30-day follow-up CCTA in 102 patients revealed a 92.6% anastomosis patency rate, with MACCE at 7.2% and major bleeding at 2.7%.

Conclusions:

• Coronary artery bypass grafting guided by CCTA is a feasible strategy for selected patients with complex coronary artery disease.
• The CCTA-guided approach demonstrates an acceptable safety profile, comparable to traditional methods.
• This non-invasive imaging modality can effectively guide surgical revascularization decisions, potentially streamlining patient management.