Abstract
Purpose: Multidetector computed tomography coronary angiography (MDCT-CA) is a non-invasive and accurate tool for the detection of obstructive coronary artery disease and for the evaluation of coronary artery bypass graft (CABG) patency and MDCT-CA appears to have prognostic value in patients without previous revascularization. However, the prognostic value of MDCT-CA in CABG patients is still unclear. Aim of the present study is to investigate the long-term prognostic value of MDCT-CA in a large population of CABG patients. Methods: Between March 2005 and April 2009, 721 CABG patients (mean age 66.8±8.4, 577 males) were enrolled in our study. Patients were classified by unprotected coronary territory (UCTs) or a summary of native vessel disease and graft patency: the coronary artery protection score (CAPS). The composite rate of hard cardiac events (cardiac death, non-fatal myocardial infarction, unstable angina) and all cardiac events (including revascularization) were end points of the study. Results: 10 patients were excluded because MDCT-CA data set was uninterpretable. Of the remaining 711, clinical follow up (mean 73.5±14 months) was obtained in 698 patients. By univariate analysis, the strongest MDCT-CA predictors of hard and all events were UCT 2 and 3 and CAPS 4 and 8. Cumulative event-free survival was 85% for hard events and 75% for all events in patients with UCT 0, 75% for hard events and 50% for all events in patients with UCT 1, 30% for hard events and 8% for all events in patients with UCT 2 and 10% for hard events and 2% for all events in patients with UCT 3. Cumulative event-free survival by CAPS ranging from 95% for hard events and 90% for all events in patients with CAPS 2 and 3% for hard events and 2% for all events in patients with CAPS 4. Conclusions: MDCT-CA appears to be a promising tool for long-term risk stratification of CABG patients. Particularly, assessing prognosis by UCTs appears to have prognostic value in CABG patients more than CAPS score.
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