Kelham, Matthew; Beirne, Anne-Marie; Rathod, Krishnaraj S; Andiapen, Mervyn; Wynne, Lucinda; Ramaseshan, Rohini; Learoyd, Annastazia E; ... BYPASS-CTCA Trial Investigators; + view all Kelham, Matthew; Beirne, Anne-Marie; Rathod, Krishnaraj S; Andiapen, Mervyn; Wynne, Lucinda; Ramaseshan, Rohini; Learoyd, Annastazia E; Forooghi, Nasim; Moon, James C; Davies, Ceri; Bourantas, Christos V; Baumbach, Andreas; Manisty, Charlotte; Wragg, Andrew; Ahluwalia, Amrita; Pugliese, Francesca; Mathur, Anthony; Jones, Daniel A; BYPASS-CTCA Trial Investigators; - view fewer (2024) The effect of CTCA guided selective invasive graft assessment on coronary angiographic parameters and outcomes: Insights from the BYPASS-CTCA trial. Journal of Cardiovascular Computed Tomography , 18 (3) pp. 291-296. 10.1016/j.jcct.2024.03.004.

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Abstract

Background: Computed tomography cardiac angiography (CTCA) is recommended for the evaluation of patients with prior coronary artery bypass graft (CABG) surgery. The BYPASS-CTCA study demonstrated that CTCA prior to invasive coronary angiography (ICA) in CABG patients leads to significant reductions in procedure time and contrast-induced nephropathy (CIN), alongside improved patient satisfaction. However, whether CTCA information was used to facilitate selective graft cannulation at ICA was not protocol mandated. In this post-hoc analysis we investigated the influence of CTCA facilitated selective graft assessment on angiographic parameters and study endpoints. // Methods: BYPASS-CTCA was a randomized controlled trial in which patients with previous CABG referred for ICA were randomized to undergo CTCA prior to ICA, or ICA alone. In this post-hoc analysis we assessed the impact of selective ICA (grafts not invasively cannulated based on the CTCA result) following CTCA versus non-selective ICA (imaging all grafts irrespective of CTCA findings). The primary endpoints were ICA procedural duration, incidence of CIN, and patient satisfaction post-ICA. Secondary endpoints included the incidence of procedural complications and 1-year major adverse cardiac events. // Results: In the CTCA cohort (n ​= ​343), 214 (62.4%) patients had selective coronary angiography performed, whereas 129 (37.6%) patients had non-selective ICA. Procedure times were significantly reduced in the selective CTCA ​+ ​ICA group compared to the non-selective CTCA ​+ ​ICA group (−5.82min, 95% CI -7.99 to −3.65, p ​< ​0.001) along with reduction of CIN (1.5% vs 5.8%, OR 0.26, 95% CI 0.10 to 0.98). No difference was seen in patient satisfaction with the ICA, however procedural complications (0.9% vs 4.7%, OR 0.21, 95% CI 0.09–0.87) and 1-year major adverse cardiac events (13.1% vs 20.9%, HR 0.55, 95% CI 0.32–0.96) were significantly lower in the selective group. // Conclusions: In patients with prior CABG, CTCA guided selective angiographic assessment of bypass grafts is associated with improved procedural parameters, lower complication rates and better 12-month outcomes. Taken in addition to the main findings of the BYPASS-CTCA trial, these results suggest a synergistic approach between CTCA and ICA should be considered in this patient group. // Registration: ClinicalTrials.gov, NCT03736018.

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