Article Impact Level: HIGH Data Quality: STRONG Summary of Circulation, CIRCULATIONAHA.123.064465. https://doi.org/10.1161/CIRCULATIONAHA.123.064465 Dr. Daniel A. Jones et al.
Points
- A recent randomized controlled trial examined the benefits of adding computed tomography cardiac angiography (CTCA) to invasive coronary angiography (ICA) for patients with coronary artery bypass grafting history.
- The study, spanning three years and involving 688 patients, demonstrated that CTCA before ICA significantly reduced the procedural duration of ICA, with an average of 18.6 minutes compared to 39.5 minutes in the ICA-alone group.
- Patients who underwent CTCA before ICA reported higher satisfaction scores following the procedure, indicating a preference for this approach.
- The study found a substantial decrease in the incidence of contrast-induced nephropathy in the CTCA+ICA group (3.4%) compared to the ICA-alone group (27.9%).
- In addition to shorter procedure times and improved patient satisfaction, the CTCA+ICA group experienced fewer procedural complications and lower 1-year major adverse cardiac events, suggesting that CTCA before ICA is a valuable approach for patients with a coronary artery bypass grafting history.
Summary
In a recent single-center, open-label, randomized controlled trial, the research team examined the potential benefits of incorporating computed tomography cardiac angiography (CTCA) as an adjunct to invasive coronary angiography (ICA) for patients with a history of coronary artery bypass grafting. The study spanned three years and involved 688 patients, with a median follow-up period of one year. Among these patients, the mean age was 69.8 years, with 108 (15.7%) being women and 402 (58.4%) identifying as White. Notably, a high prevalence of comorbidities was observed, with 85.3% of patients having hypertension and 53.8% having diabetes.
Furthermore, the median time elapsed between coronary artery bypass grafting and angiography was 12.0 years, and on average, each participant had three grafts (interquartile range, 2 to 3). The researchers examined several key outcomes to assess the impact of CTCA on the patient population. Most prominently, the study revealed that the procedure duration of ICA was significantly reduced in the CTCA+ICA group. In this group, the average procedural duration was 18.6±9.5 minutes, whereas it was 39.5±16.9 minutes in the ICA-alone group, a statistically significant result (98.33% CI, −23.5 to −18.4; P<0.001).
Moreover, patients who underwent CTCA before ICA reported higher satisfaction scores following the procedure, with a difference of -1.1 on a scale ranging from 1 (very good) to 5 (very poor). This result was also statistically significant (98.33% CI, -1.2 to -0.9; P<0.001). Additionally, the study demonstrated a marked reduction in the incidence of contrast-induced nephropathy in the CTCA+ICA group, with only 3.4% of patients affected, compared to 27.9% in the ICA-alone group (odds ratio, 0.09; 98.33% CI, 0.04–0.2; P<0.001).
The advantages of CTCA extended beyond these primary endpoints, as the study also found a significant decrease in procedural complications (2.3% in the CTCA+ICA group versus 10.8% in the ICA-alone group; odds ratio, 0.2; 95% CI, 0.1–0.4; P<0.001). Furthermore, 1-year major adverse cardiac events were substantially reduced in the CTCA+ICA group (16.0%) compared to the ICA-alone group (29.4%; hazard ratio, 0.4; 95% CI, 0.3–0.6; P<0.001). These comprehensive findings underscore the potential advantages of implementing CTCA before ICA for patients with a coronary artery bypass grafting history, providing critical insights for managing this specific patient population.
Link to the article: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.064465
References Jones, D. A., Beirne, A.-M., Kelham, M., Rathod, K. S., Andiapen, M., Wynne, L., Godec, T., Forooghi, N., Ramaseshan, R., Moon, J. C., Davies, C., Bourantas, C. V., Baumbach, A., Manisty, C., Wragg, A., Ahluwalia, A., Pugliese, F., Mathur, A., Bourantas, C., … Hall, R. (2023). Computed tomography cardiac angiography before invasive coronary angiography in patients with previous bypass surgery: The bypass-ctca trial. Circulation, CIRCULATIONAHA.123.064465. https://doi.org/10.1161/CIRCULATIONAHA.123.064465
