Diagnostic Accuracy of Computed Tomography Angiography in Patients After Bypass Grafting Comparison With Invasive Coronary Angiography

OBJECTIVES We sought to evaluate the contribution of noninvasive dual-source computed tomography angiography (CTA) in the comprehensive assessment of symptomatic patients after coronary artery bypass grafting (CABG). BACKGROUND Assessment of bypass grafts and distal runoffs by invasive coronary angiography is cumbersome and often requires extra procedure time, contrast load, and radiation exposure. METHODS Dual-source CTA was performed in 52 (41 men, mean age 66.6 +/- 13.2 years) symptomatic post-CABG patients scheduled for invasive coronary angiography. No oral or intravenous beta blockers or sedation were administered before the scan. Mean interval between CABG surgery and CTA was 9.6 +/- 7.2 (range 0 to 20) years. Mean heart rate during scanning was 64.5 +/- 13.2 (range 48 to 92) beats/min. Seventy-five percent of patients had both arterial and venous grafts. A total of 152 graft segments and 142 distal runoffs vessels were analyzed. Native coronary segments were divided into nongrafted (n = 118) and grafted segments (n = 289). A significant stenosis was defined as >= 50% lumen diameter reduction, and quantitative coronary angiography served as reference standard. RESULTS The diagnostic accuracy of CTA for the detection or exclusion of significant stenosis in arterial and venous grafts on a segment-by-segment analysis was 100%. Sensitivity, specificity, positive predictive value, and negative predictive value to detect significant stenosis were 95% (95% confidence interval [CI]: 73% to 100%), 100% (95% CI: 96% to 100%), 100% (95% CI: 79% to 100%), 99% (95% CI: 95% to 100%) in distal runoffs respectively; 100% (95% CI: 97% to 100%), 96% (95% CI: 90% to 98%), 97% (95% CI: 93% to 99%), 100% (95% CI: 95% to 100%) in grafted native coronary arteries respectively; and 97% (95% CI: 83% to 100%), 92% (95% CI: 83% to 96%), 83% (95% CI: 67% to 92%), 99% (95% CI: 92% to 100%) in nongrafted native coronary arteries, respectively. CONCLUSIONS Noninvasive CTA is successful for evaluating bypass grafts in symptomatic post-CABG patients, whereas invasive coronary angiography is still required for the assessment of significant stenosis in distal runoffs and native coronary arteries. (J Am Coll Cardiol Img 2009; 2: 816-24) (C) 2009 by the American College of Cardiology Foundation