Comparison of Diagnostic Accuracy of Multislice CT Angiography with Conventional Coronary Angiography in bypass Graft Stenosis Morethan 50% Among Symptomatic Patients after Coronary Artery Bypass Graft Surgery

Authors

1 Department of Cardiovascular Diseases, Atherosclosis Cardiovascular Research Center (ACRC).Ahvaz Jundishpur University of Medical Sciences, Ahvaz, Iran.

2 Department of Radiology, Ahvaz Jundishpur University of Medical Sciences, Ahvaz, Iran.

Abstract

Abstract
Background and Objective: Conventional coronary angiography is the gold standard technique for evaluation of coronary bypass grafts stenosis. This study was carried out to find diagnostic accuracy of multisclice 64 CT angiography in diagnosis of bypass graft stenosis rather than conventional coronary angiography.
Subjects and Methods: This prospective and retrospective study was performed in university and private hospitals in Ahvaz, Iran from 2007 to 2012. All data were collected from patients with past history of coronary artery bypass surgery (CABG) who presented with chest pain or ischemia according to noninvasive test had indication for conventional coronary angiography. Arterial and venous grafts from 143 patients were assessed by CT angiography and conventional angiography was takenfrom 53 patients with history of CABG. All data was collected and analyzed bySPSS version 17.
Results:The mean age of men was 59.4±10 and women 59.9±8 years (34% were females and 66% were males). Sensitivity , specificity, positive and negative predictive value  and diagnostic accuracy in CT angiography were respectively 95, 100, 100, 86 and96% in proximal and 100,100,100,100,and 100% in middle part;  and 71, 96,93,83 and 86% in distal part of arterial and vein graft bypass in comparison with invasive conventional coronary angiography.
Conclusion:Diagnosis of occlusion and stenosis of arterial and venous bypass grafts by CTangiography is accurate and effectiveand may be decrease conventional coronary angiography among patients with CABG

Keywords

References

1-Rosamond W, Flegal K, Furie K, Go A, Greenlund K, Haase N, et al.  Heart disease and stroke statistics-2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2008;117(4):e25-146.
2-Noto TJ Jr, Johnson LW, Krone R, Weaver WF, Clark DA, Kramer JR Jr, et al. Cardiac catheterization 1990: a report of the Registry of the Society for Cardiac Angiography and Interventions (SCA&I). Cathet Cardiovasc Diagn 1991;24(2):75-83.
3-Scanlon PJ, Faxon DP, Audet AM, Carabello B, Dehmer GJ, Eagle KA, et al. ACC/AHA guidelines for coronary angiography: executive summary and recommendations. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography) developed in collaboration with the Society for Cardiac Angiography and Interventions. Circulation 1999;99(17):2345-57.
4-Pache G, Saueressig U, Frydrychowicz A, Foell D, Ghanem N, Kotter E, et al. Initial experience with 64-slice cardiac CT: non-invasive visualization of coronary artery bypass grafts. Eur Heart J 2006;27(8):976–80.
5-Tan ES, van der Meer J, Jan de Kam P, Dunselman PH, Mulder BJ, Ascoop CA, et al. Worse clinical outcome but similar graft patency in women versus men one year after coronary artery bypass graft surgery owing to an excess of exposed risk factors in women. CABADAS. Research Group of the Interuniversity Cardiology Institute of The Netherlands. Coronary Artery Bypass graft occlusion by Aspirin, Dipyridamole and Acenocoumarol/phenoprocoumon Study. J Am Coll Cardiol 1999;34(6):1760-8.
6-Heart and stroke statistical update. Heart Disease & Stroke Statistics,Our guide to current statistics and the supplement to our Heart & StrokeFacts, American Heart Association. 2009 Update At-A-Glance.
7-Schoepf UJ, Becker CR, Ohnesorge BM, Yucel EK. CT of coronary artery disease. Radiology 2004;232(1):18–37.
8-de Feyter PJ, Nieman K. Noninvasive multi-slice computed tomography coronary angiography: an emerging clinical modality. J Am Coll Cardiol 2004;44(6):1238–40.
9-Schlosser T, Konorza T, Hunold P, Kühl H, Schmermund A, Barkhausen J. Noninvasive visualization of coronary artery bypass grafts using 16-detector row computed tomography. J Am Coll Cardiol 2004;44(6):1224–9.
10-Hannan EL, Racz MJ, Walford G, Jones RH, Ryan TJ, Bennett E, et al. Long-term outcomes of coronary-artery bypass grafting versus stent implantation. N Engl J Med 2005;352(21):2174–83.
11-Myers WO, Blackstone EH, Davis K, Foster ED, Kaiser GC.CASS Registry long term surgical survival.Coronary Artery Surgery Study. J Am Coll Cardiol 1999;33(2):488–98.
12-Nieman K, Pattynama PM, Rensing BJ, Van Geuns RJ, De Feyter PJ. Evaluation of patients after coronary artery bypass surgery: CT angiographic assessment of grafts and coronary arteries. Radiology 2003;229(3):749–56.
13- Schuijf JD, Bax JJ, Salm LP, Jukema JW, Lamb HJ, van der Wall EE, et al. Noninvasive coronary imaging and assessment of left ventricular function using 16-slice computed tomography. Am J Cardiol 2005;95(5):571–4.
14-Probst C, Kovacs A, Schmitz C, Schiller W, Schild H, Welz A. Quantification of coronary artery stenosis with 16-slice MSCT in patients before CABG surgery: comparison to standard invasive coronary angiography. Heart Surg Forum 2005;8(1):E42–6.
15-Beck T, Burgstahler C, Kuettner A, Kopp AF, Heuschmid M, Claussen CD, et al. Clinical use of multislice spiral computed tomography in 210 highly preselected patients: experience with 4 and 16 slice technology. Heart 2005;91(11):1423-7.
16-Chiurlia E, Menozzi M, Ratti C, Romagnoli R, Modena MG. Follow-up of coronary artery bypass graft patency by multislice computed tomography. Am J Cardiol 2005;95(9):1094–7.
17-Wintersperger BJ, Bastarrika G, Nikolaou K, Rist C, Huber A, Knez A, et al. [ECG-gated bypass CT angiography--application in imaging arterial bypasses]. Radiology 2004;44:140–5. [In German]
18-Lee YW, Yang CC, Mok GS, Law WY, Su CT, Wu TH. Prospectively versus retrospectively ECG-gated 256-slice CT angiography to assess coronary artery bypass grafts--comparison of image quality and radiation dose.PLoS One 2012;7(11):e49212.doi:10.1371
19-Yoo KJ, Choi D, Choi BW, Lim SH, Chang BC. The comparison of the graft patency after coronary artery bypass grafting using coronary angiography and multi-slice computed tomography. Eur J Cardiothorac Surg 2003;24(1):86-91.
20-Burgstahler C, Beck T, Kuettner A, Drosch T, Kopp AF, Heuschmid M, et al. Non-invasive evaluation of coronary artery bypass grafts using 16-row multi-slice computed tomography with 188 ms temporal resolution.Int J Cardiol. 2006 Jan 13;106(2):244-9.
21-Martuscelli E, Romagnoli A, D'Eliseo A, Tomassini M, Razzini C, Sperandio M, et al. Evaluation of venous and arterial conduit patency by 16-slice spiral computed tomography. Circulation 2004;110(20):3234-8.
22-Anders K, Baum U, Schmid M, Ropers D, Schmid A, Pohle K, et al. Coronary artery bypass graft (CABG) patency: assessment with high-resolution submillimeter 16-slice multidetector-row computed tomography (MDCT) versus coronary angiography. Eur J Radiol 2006; 57(3):336-44.
23-Uva MS, Matias F, Mesquita A, Costa R, Baú J, Pedro A, et al. Sixteen-slice multidetector computed tomography for graft patency evaluation after coronary artery bypass surgery. J Card Surg 2008;23(1):17-22.
24-Auguadro C, Manfredi M, Scalise F, Mustica T, Vanoli E, Khouri T, et al. Multislice computed tomography for the evaluation of coronary bypass grafts and native coronary arteries: comparison with traditional angiography.J Cardiovasc Med (Hagerstown) 2009;10(6):454-60.
25-Malagutti P, Nieman K, Meijboom WB, van Mieghem CA, Pugliese F, Cademartiri F, etal. Use of 64-slice CT in symptomatic patients after coronary bypass surgery: evaluation of grafts and coronary arteries.Eur Heart J 2007;28(15):1879-85.
26-Gopalakrishnan P, Wilson GT, Tak T. Accuracy of multislice computed tomography coronary angiography: a pooled estimate.Cardiol Rev 2008;16(4):189-96.
27-Eagle KA, Guyton RA, Davidoff R, Edwards FH, Ewy GA, Gardner TJ, et al. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Circulation 2004;110(14):e340-437.
28-Cameron A, Davis KB, Green G, Schaff HV. Coronary bypass surgery with internal-thoracic-artery grafts--effects on survival over a 15-year period. N Engl J Med 1996;334(4):216-9.
29-Achenbach S, Moshage W, Ropers D, Nossen J, Bachmann K. Noninvasive, three-dimensional visualization of coronary artery bypass grafts by electron beam tomography. Am J Cardiol 1997;79(7):856-61.
30-Marano R, Liguori C, Rinaldi P, Storto ML, Politi MA, Savino G, et al. Coronary artery bypass grafts and MDCT imaging: What to know and what to look for. Eur Radiol 2007;17(12):3166-78.
31-Motwani JG, Topol EJ. Aortocoronary saphenous vein graft disease: Pathogenesis, predisposition, and prevention. Circulation 1998;97(9):916-31.
32-Marano R, Storto ML, Merlino B, Maddestra N, Di Giammarco G, Bonomo L. A pictorial review of coronary artery bypass grafts at multidetector row CT. Chest 2005;127(4):1371-7.
33-Frazier AA, Qureshi F, Read KM, Gilkeson RC, Poston RS, White CS. Coronary artery bypass grafts: assessment with multidetector CT in the early and late postoperative settings. Radiographics 2005;25(4):881-96.
34-Mueller J, Jeudy J, Poston R, White CS. Cardiac CT angiography after coronary bypass surgery: Prevalence of incidental findings. AJR Am J Roentgenol 2007;189(2):414-9.
35-Trigo Bautista A, Estornell J, Ridocci F, Soriano CJ, Gudín M, Vilar JV, et al. [Non-invasive assessment of coronary artery bypass grafts by computed tomography: comparison with conventional coronary angiography]. Rev Esp Cardiol 2005;58(7):807-14. [In Spanish]
36-Türkvatan A, Biyikoğlu SF, Büyükbayraktar FG, Cumhur T, Duru E, Olçer T, et al. Noninvasive  evaluation of coronary artery bypass grafts and native coronary arteries: is 16-slice multidetector CT usfule? Diagn Interv Radiol 2009;15(1):43-50.
Jundishapur Scientific Medical Journal
Volume 12, Issue 3 - Serial Number 84
July and August 2013
Pages 243-252

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History

  • Receive Date: 07 October 2012
  • Revise Date: 19 January 2013
  • Accept Date: 20 February 2013

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