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JACC Cardiovasc Imaging. 2009 Jul;2(7):816-24. doi: 10.1016/j.jcmg.2009.02.010.

Diagnostic accuracy of computed tomography angiography in patients after bypass grafting: comparison with invasive coronary angiography.

Author information

1
Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands.

Erratum in

  • JACC Cardiovasc Imaging. 2010 May;3(5):553. Meijboom, Bob W [corrected to Meijboom, W Bob].

Abstract

OBJECTIVES:

We sought to evaluate the contribution of noninvasive dual-source computed tomography angiography (CTA) in the comprehensive assessment of symptomatic patients after coronary artery bypass grafting (CABG).

BACKGROUND:

Assessment of bypass grafts and distal runoffs by invasive coronary angiography is cumbersome and often requires extra procedure time, contrast load, and radiation exposure.

METHODS:

Dual-source CTA was performed in 52 (41 men, mean age 66.6 +/- 13.2 years) symptomatic post-CABG patients scheduled for invasive coronary angiography. No oral or intravenous beta blockers or sedation were administered before the scan. Mean interval between CABG surgery and CTA was 9.6 +/- 7.2 (range 0 to 20) years. Mean heart rate during scanning was 64.5 +/- 13.2 (range 48 to 92) beats/min. Seventy-five percent of patients had both arterial and venous grafts. A total of 152 graft segments and 142 distal runoffs vessels were analyzed. Native coronary segments were divided into nongrafted (n = 118) and grafted segments (n = 289). A significant stenosis was defined as >or=50% lumen diameter reduction, and quantitative coronary angiography served as reference standard.

RESULTS:

The diagnostic accuracy of CTA for the detection or exclusion of significant stenosis in arterial and venous grafts on a segment-by-segment analysis was 100%. Sensitivity, specificity, positive predictive value, and negative predictive value to detect significant stenosis were 95% (95% confidence interval [CI]: 73% to 100%), 100% (95% CI: 96% to 100%), 100% (95% CI: 79% to 100%), 99% (95% CI: 95% to 100%) in distal runoffs respectively; 100% (95% CI: 97% to 100%), 96% (95% CI: 90% to 98%), 97% (95% CI: 93% to 99%), 100% (95% CI: 95% to 100%) in grafted native coronary arteries respectively; and 97% (95% CI: 83% to 100%), 92% (95% CI: 83% to 96%), 83% (95% CI: 67% to 92%), 99% (95% CI: 92% to 100%) in nongrafted native coronary arteries, respectively.

CONCLUSIONS:

Noninvasive CTA is successful for evaluating bypass grafts in symptomatic post-CABG patients, whereas invasive coronary angiography is still required for the assessment of significant stenosis in distal runoffs and native coronary arteries.

PMID:
19608130
DOI:
10.1016/j.jcmg.2009.02.010
[Indexed for MEDLINE]
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