The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

An Observational Study assessing the value of Computed Tomography Cardiac Angiography (CTCA) in planning invasive angiographic procedures in patients with previous coronary artery bypass grafting (CABG)

DOI: 10.4244/EIJ-D-18-01185

1. Barts Interventional Group, Barts Heart Center, Barts Health NHS Trust, London; Parts Cardiovascular Clinical Trials Unit, Queen Mary University of London; Department of Cardiac Imaging, Parts Heart Center, Parts Health NHS Trust, London, UNITED KINGDOM
2. Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London; Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London
3. Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London
4. Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London
5. Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London
6. Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London
7. Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London
8. Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London
9. Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London; Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London
10. Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London; Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London
11. Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London; Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London
12. Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, London
13. Barts Interventional Group, Barts Heart Centre, Barts Health NHS Trust, London; Barts Cardiovascular Clinical Trials Unit, Queen Mary University of London
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Aims: Invasive Coronary angiography (ICA) is more complex and challenging in patients with previous CABG. Computerised Tomography Coronary Angiography (CTCA) may provide useful information prior to ICA to improve these procedures. 

Methods and results: This single-centre observational study included 835 patients with prior CABG undergoing invasive coronary angiography. 106 patients underwent CTCA prior to ICA and were compared to 729 patients undergoing conventional coronary angiography alone (control group). No significant differences were seen between the 2 groups in patient demographics and procedure characteristics (number of bypass grafts), and interventional cardiologist’s experience. The CTCA group had lower contrast volumes (171.3mls vs 287.4mls, p<0.0001), radiation doses (Effective dose 4.6mSv vs 10.5mSv, p<0.0001) and procedure times (fluorosocopy time 9.5min vs 12.6min, p<0.0001) at the time of ICA compared to patients who did not have prior CTCA. Combined radiation doses (ICA + CTCA) vs ICA alone were similar (p=0.867) with significant reductions in overall contrast used seen in the CTCA group (p=0.005). Complete diagnostic studies were performed in all patients with prior CTCA (106 patients, 100%) compared to 543 patients (74.64%, p= <0.0001) of patients without previous CTCA, as a result 34 patients (4.4%) went on to have CTCA post angiography due to missed grafts. Of these 4 needed further invasive angiographic assessment and subsequent coronary intervention following the CTCA scan. 

Conclusions: Prior CTCA improves graft detection at the time in coronary angiography and reduces the time necessary to localize graft ostium, the total procedure time duration, and volume of contrast media used

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