Abstract 16715: Anatomical Data Defined by 64-Slice CT Angiography Predicts Prognosis of Coronary Artery by-Pass Patients More Accurately That Clinical Risk Predictors

Abstract

Objective: We sought to determine the incremental prognostic value of 64 multi-slice coronary computed tomography angiography (CCTA) in coronary artery bypass (CABG) patients. Background: Prognostication in CABG patients can be difficult. Anatomical assessment of native coronary artery disease and graft patency may provide useful information, but the utility of CCTA in the assessment of CABG patients is unknown. Methods: 657 CABG patients with all cause mortality follow up were identified from a multicenter CCTA registry, of 10,628 patients from 5 CCTA centres. Clinical risk was profiled with modified logistic and additive EuroSCOREs. CCTA defined coronary anatomy. Patients were classified by unprotected coronary territory (UCT), or a summary of native vessel disease and graft patency: the coronary artery protection score (CAPS). Results: 76.6% of patients were male and the median age was 68 years. 44 deaths occurred over 48 months follow-up. LVEF, creatinine, age, severity of native vessel disease, UCT, CAPS and EuroSCOREs were univariate predictors of mortality (p<0.001). In multivariate analysis using additive EuroSCORE, UCT (p=0.004) and CAPS were predictive of events (p<0.001). In comparison to additive EuroSCORE, CAPS score was associated with a 27% net reclassification index. Conclusions: CCTA provides incremental anatomical data to clinical risk assessment to better determine the prognosis of symptomatic patients post CABG. CAPS evaluation using CCTA may help determine those patients at highest risk.