Prognostic value of 256-row coronary computed tomography angiography in symptomatic patients with a history of coronary artery bypass surgery

Abstract

Purpose: Contrast-enhanced 256-row coronary computed tomography angiography (CCTA) has high diagnostic accuracy for diagnosing coronary stenosis, but its role in predicting late clinical outcome events in pts with a history of coronary artery bypass surgery (CABG) has not been well studied. Methods: We examined the predictive value of CCTA for late major adverse cardiovascular (CV) outcome events (MACE) (CV death or non-fatal MI) in 170 pts (136 (80%) men) with a history of CABG (average 2.9 grafts/pt) who presented with a chest pain syndrome. Outcome events in relation to graft patency/occlusion and extent of native vessel coronary artery disease (CAD) by CCTA were evaluated using Cox models. Results: On CCTA, 151/491 (31%) grafts were occluded (38/232 (16%) arterial, 113/259 (44%) venous). 115/170 (67%) pts had high risk native coronary anatomy (HRCA) (triple vessel and/or left main CAD). During a mean follow-up of 2.5±1.4 years MACE occurred in 33/170 (19%) pts (MACE rate 7.6%/year); CV death in 21/170 (12%) and non fatal MI in 12/170 (7%). By univariate analysis, presence of ≥2 occluded grafts on CCTA was associated with a twofold increase in MACE (30% (14/46) vs 15% (19/124), HR=2.1, p=0.04) (Figure), and remained significant (HR 2.1, p=0.03) after adjusting for other variables (age, gender, coronary risk factors, LV function, native vessel HRCA). ![Figure][1] Conclusions: In pts with a history of CABG undergoing evaluation for a chest pain syndrome; presence of ≥2 occluded grafts on CCTA was associated with increased risk of CV death or MI during 2.5 years follow-up. 256-row CCTA is useful in predicting late clinical outcome events after CABG. [1]: pending:yes