Meta-Analysis of Coronary Bypass Graft Patency Assessment With Invasive vs Computed Tomographic Angiography

Computed tomographic (CT) coronary angiography has emerged as a noninvasive alternative for evaluating graft patency after coronary artery bypass grafting (CABG), but there is ongoing debate regarding its diagnostic performance compared with invasive coronary angiography, particularly for arterial and composite grafts.

MEDLINE (Medical Literature Analysis and Retrieval System Online), Embase, and Cochrane databases were searched to identify studies comparing CT coronary angiography with invasive coronary angiography for detection of graft occlusion in patients who had undergone CABG. Outcomes included sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy. Meta-regression explored key modifiers. Pooled estimates were calculated using random-effects models, with heterogeneity measured by I².

Fifty studies met inclusion criteria, including 3449 patients (25% women). CT coronary angiography sensitivity for graft occlusion was 0.96 (I² = 48%), specificity was 0.97 (I² = 46%), positive predictive value was 0.94 (I² = 62%), negative predictive value was 0.98 (I² = 41%), and overall diagnostic accuracy was 0.97 (I² = 58%). The pooled incidence rate of graft occlusion across 7506 included grafts was 0.08 per graft-year (95% CI, 0.06-0.10) using a random-effects model and 0.07 per graft-year (95% CI, 0.07-0.08) using a fixed-effects model. At meta-regression, study year, sample size, β-blocker use, number of slices, and time since surgery, but not type and configuration of CABG grafts, were significantly associated with CT coronary angiography sensitivity.

CT coronary angiography detects CABG graft occlusion with a high degree of sensitivity and specificity independently of graft type and configuration and can be used for imaging of every type of CABG graft.