CCTA-Guided Invasive Coronary Angiography in Patients With CABG: A Multicenter, Randomized Study
Background
Coronary computed tomography angiography (CCTA) is highly accurate in visualizing grafts in patients with prior coronary artery bypass graft (CABG). Invasive coronary angiography (ICA) in these patients is associated with longer procedural time, increased contrast agent use, radiation exposure, and complications compared to non-CABG patients.
Methods
This multicenter, randomized controlled trial compared the strategy of CCTA-guided ICA versus classic ICA in patients with prior CABG. Patients were randomly assigned to have a CCTA before ICA (CCTA-ICA group) or not (ICA-only group).
Results
The study included 225 patients, with 110 in the CCTA-ICA group and 115 in the ICA-only group. The total contrast volume was higher in the CCTA-ICA group, but the contrast volume administered during the invasive procedure was lower. Total fluoroscopy time was decreased in the CCTA-ICA group, but total effective radiation dose was increased. Rates of contrast-induced nephropathy, periprocedural complications, and major adverse cardiac events did not significantly differ between the two groups.
Conclusions
A CCTA-directed ICA strategy for patients with CABG expedites the invasive procedure and reduces fluoroscopy time, but comes with higher total contrast volume and effective radiation dose compared to the classic ICA approach.
Registration: ClinicalTrials.gov; Unique identifier: NCT04631809.
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