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Published on: August 28, 2018
CCTA-Guided Invasive Coronary Angiography in Patients With CABG: A Multicenter, Randomized Study
Grigorios Tsigkas1, Fotios Toulgaridis2, Anastasios Apostolos3
1Department of Cardiology (G.T., G.V., A.M., P.D.), University Hospital of Patras, Greece.
Insights
Coronary computed tomography angiography (CCTA)-guided invasive coronary angiography (ICA) in post-coronary artery bypass graft (CABG) patients reduces procedure time and fluoroscopy. However, this strategy increases total contrast volume and radiation exposure without significantly altering complication rates.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Radiology
Background:
- Coronary computed tomography angiography (CCTA) accurately visualizes bypass grafts.
- Invasive coronary angiography (ICA) in patients with prior coronary artery bypass graft (CABG) is resource-intensive.
- Previous studies highlight challenges in assessing graft patency post-CABG.
Purpose of the Study:
- To compare CCTA-guided ICA versus classic ICA in patients with prior CABG.
- To evaluate the impact of a CCTA-guided strategy on procedural outcomes.
- To assess the safety and efficacy of CCTA-guided ICA in the CABG population.
Main Methods:
- Multicenter, randomized controlled trial comparing CCTA-ICA versus ICA-only strategies.
- Random assignment of patients with prior CABG to one of two groups (1:1 ratio).
- Primary endpoint: total contrast agent volume administered.
Main Results:
- CCTA-ICA group had higher total contrast volume but lower intra-procedural contrast volume.
- Significant reduction in total fluoroscopy time observed in the CCTA-ICA group.
- No significant differences in contrast-induced nephropathy, complications, or major adverse cardiac events.
Conclusions:
- A CCTA-directed ICA strategy expedites invasive procedures and reduces fluoroscopy time in CABG patients.
- This approach leads to increased total contrast volume and effective radiation dose.
- The CCTA-guided strategy offers procedural efficiencies without compromising patient safety regarding key adverse events.
Background:
Coronary computed tomography angiography (CCTA) in patients with post-coronary artery bypass graft (CABG) has a high diagnostic accuracy for visualization of grafts. Invasive coronary angiography (ICA) in patients with CABG is associated with increased procedural time, contrast agent administration, radiation exposure, and complications, compared with non-CABG patients. The aim of this multicenter, randomized controlled trial was to compare the strategy of CCTA-guided ICA versus classic ICA in patients with prior CABG.
Methods:
Patients with prior CABG were randomly assigned (1:1 ratio) to have a CCTA before ICA (CCTA-ICA, group A) or not (ICA-only, group B). The primary end point of the study was the total volume (milliliters) of the contrast agent administered.
Results:
A total of 251 patients were randomized, and 225 were included in analysis; 110 in group A and 115 in group B. The total contrast volume was higher in group A (184.5 [143-255] versus 154 [102-240] mL; P=0.001). The contrast volume administered during the invasive procedure was lower in group A (101.5 [60-151] versus 154 [102-240]; P<0.001). Total fluoroscopy time was decreased in group A (480 [259-873] versus 594 [360-1080] seconds; P=0.027), but total effective dose was increased (24.1 [17.7-32] versus 10.8 [5.6-18] mSv; P<0.001). The rate of contrast-induced nephropathy, periprocedural complications, and major adverse cardiac events during 3 to 5 and 30 days did not differ significantly between the 2 groups.
Conclusions:
A CCTA-directed ICA strategy for patients with CABG is associated with expedition of the invasive procedure, and less fluoroscopy time, at the cost of higher total contrast volume and effective radiation dose, compared with the classic ICA approach.
Registration:
URL: https://www.clinicaltrials.gov; Unique identifier: NCT04631809.
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