Computed tomography coronary angiography (CTCA) can help prevent procedural complications in patients with previous coronary artery bypass grafting (CABG) undergoing invasive coronary angiography (ICA), suggests a new study.
Presenting at the Transcatheter Cardiovascular Therapeutics (TCT) 2022 conference in Boston, Daniel Jones MRCP, PhD, MSc, of the Barts Cardiovascular Clinical Trials Unit (CVCTU) in London, also found CTCA could reduce procedure time and improve patient satisfaction.
“The long-term results of CABG are hampered by the gradual failure of bypass conduits and the progression of native atherosclerotic disease,” said Jones. “This is particularly true for saphenous vein grafts (SVG), where up to 40% are occluded by 1 year and 90% by 10 years.”
“The problem with ICA in patients with previous CABG is that it is more complex and challenging requiring multiple catheter manipulations to engage the grafts as the location of the bypass ostia is variable. No operation is the same.”
CABG is the most common adult cardiac procedure in the developed world, where worldwide 1.6 million surgeries are performed per year with approximately 250,000 cases in the U.S. per year. Around 1 in 5 patients will require invasive coronary angiography within 3 years of undergoing CABG.
The study was a randomized trial of 688 patients carried out at Barts Heart Centre in London
Three primary endpoints were identified – procedural duration, patient satisfaction scores post-ICA and amount of kidney damage cause by the ICA procedure (contrast-induced nephropathy).
“Over the past decade, improvements in CTCA technology have allowed its emergence as a useful clinical tool in CABG assessment,” Jones pointed out.
“Technical advances such as the introduction of new third-generation dual-source CT scanners now means that bypass grafts can be visualized with minimal contrast.”
A set of secondary endpoints were agreed on, namely complications associated with ICA, clinical events out to 12 months and patient-related quality of life at 12 months.
Study results noted a 66% reduction in procedural duration (17.4 ± 10.2 mins vs 39.5 ± 16.9 mins) and a 92% relative risk reduction in contrast-induced nephropathy incidences (3.2% vs 27.9%).
Patient satisfaction scores benefited from a 40% relative improvement in the CTCA group compared to the ICA-alone group, and there was an 80% reduction noted in procedural complications incidences such as a heart attack, bleeding or stroke in the CTCA group (2.4% vs. 10.8%).
Quality of life also improved after 12 months, being 7.7% greater in the CTCA group. The study team also observed a difference in clinical events after 12 months, which Jones said was driven by “the reduction in spontaneousmyocardial infarction in the CT arm.”
“ICA in patients with previous CABG is common. It's typically complex and challenging,” added Jones.
“But upfront CT can mean that we reduce procedure time, we reduce contrast volume administered during the procedure and reduce complications. This should result in decreased contrast induced nephropathy and greater patient satisfaction.”
Image Credit: Jason Wermers/CRTonline.org