Studies have shown that the use of computed tomography cardiac angiography (CTCA) prior invasive coronary angiography (ICA) in patients with prior cardiac artery bypass graft (CABG) might reduce procedural time and post procedure kidney injury. 1 out of 5 patients with ischemic cardiomyopathy and prior CABG need to be assessed with ICA within 3 years after procedure.
The aim of this single center, prospective, randomized study called BYPASS CTCA was to assess whether the use of CTCA can reduce procedural time, improve patient satisfaction and prevent procedural complication in CABG patients assessed by ICA.
It included 688 patients. 344 were randomized to CTCA + ICA and 344 to ICA alone. Mean age was 70 and most patients were men.
Primary end point was procedure duration, incidence of contrast induced nephropathy and patient satisfaction assessed by a score. Secondary end point included procedural complications and major cardiovascular events (MACE) at 12 months.
As regards primary end point, the use of CTCA saw an improvement associated to the invasive study. Procedure duration was 17.38 minutes with CTCA vs 39.5 without it, with 66% relative risk reduction (p<0.001), and patient satisfaction improved 40% with the use of CTCA (p<0.001), while contrast induced nephropathy incidence was 27.9% without CTCA vs 3.4% with CTCA (92% relative risk reduction, p<0.0001).
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As regards secondary end point, the use of CTCA + ICA resulted in lower procedural complications (2.33% vs 10.82%, p<0.001) and MACE rates at 12 months (16.28 vs 29.36%, p< 0.002).
Conclusion
In patients with prior CABG undergoing invasive coronary angiogram, the use of CTCA should be considered, seeing as is shortens procedural time, improves patient satisfaction and reduces contrast induced nephropathy. In addition, the use of CTCA reduces complications rate and MACE rate at 12 months.
Dr. Andrés Rodríguez.
Member of the Editorial Board of SOLACI.org.
Original Title: A Randomized Controlled Trial Assessing The Value Of Computed Tomography Cardiac Angiography (CTCA) In Improving Patient Satisfaction And Reducing Contrast Load, Procedural Duration And Complications In Patients Who Had Previous Bypass Operation (CABG). Results from the BYPASS CTCA Trial.
Reference: Daniel A. Jones et al.
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