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BYPASS-CTCA: New Study Examines Procedural Metrics of CT Scan Prior to Invasive Coronary Angiography in Patients With Prior Bypass Surgery
BOSTON – September 19, 2022 – Study findings show that computed tomography cardiac angiography (CTCA) prior to invasive coronary angiography (ICA) in patients who have previously undergone coronary artery bypass grafting (CABG) can reduce the procedural duration and post-procedural kidney injury as well as improve patient satisfaction.
Findings were reported at TCT 2022, the 34th annual scientific symposium of the Cardiovascular Research Foundation (CRF). TCT is the world’s premier educational meeting specializing in interventional cardiovascular medicine.
Studies have shown that one in five patients with ischemic heart disease who have undergone CABG will need coronary evaluation by means of ICA within three years. Although ICA is effective, there are several risks associated with the procedure and the risk of complications is increased in patients with previous CABG. Catheter manipulation to engage the grafts is associated with an increased risk of embolic stroke or dissection, as graft engagement is technically more difficult than native vessels since the location of the bypass ostia are often variable.
The BYPASS-CTCA study was a prospective, single-center, randomized controlled trial. A total of 688 patients with previous CABG, requiring ICA for standard indications were randomized to receive CTCA prior to ICA or ICA alone at St Bartholomew’s Hospital in London.
The primary endpoints were ICA procedural duration, incidence of contrast-induced nephropathy (CIN) and patient satisfaction scores post-ICA. All three of the primary endpoints saw improvement with the use of CTCA. Procedural duration was 17.38 minutes for CTCA compared to 39.50 without CTCA (a 66% relative reduction, p<0.001). Patient satisfaction scores post ICA saw a 40% relative improvement with CTCA (1.49 versus 2.54, p<0.001). The amount of contrast-induced acute kidney injury caused by the ICA procedure was 3.4% with CTCA compared to 27.9% without (p<0.0001), a 92% relative risk reduction.
The secondary endpoints included procedure metrics, procedural complications, and major adverse cardiovascular events (all-cause mortality, myocardial infarction, unscheduled revascularization) over 12 months. CTCA use resulted in lower procedural complication rates (2.33% vs. 10.82%, p<0.001) and reduced rates of MACE at 12 months [16.28% versus 29.36%, 0.46 (0.32-0.66), p<0.002].
“Our study found that the use of CTCA prior to ICA in patients with previous CABG can shorten procedure duration, reduce rates of kidney injury, and improve patient satisfaction,” said Daniel A. Jones, MRCP, PhD, MSc, Clinical Senior Lecturer at Queen Mary University of London and Interventional Cardiologist, Barts Heart Centre. “When possible, CTCA should be considered for any stable post-bypass patient undergoing invasive coronary angiography.”
The study was funded by National Institute of Health Research, Research for Patient Benefit award (PB-PG-1216-20028) with additional funding for Dr Jones by The Barts Charity Cardiovascular Programme Award (G00913). Dr. Jones had no disclosures to report.
About CRF and TCT
The Cardiovascular Research Foundation (CRF) is one of the world’s leading nonprofit organizations specializing in interventional cardiology innovation, research, and education. CRF is dedicated to helping doctors improve survival and quality of life for people suffering from heart and vascular disease. For over 30 years, CRF has helped accelerate medical breakthroughs and educated doctors on the latest treatments for heart disease. CRF’s centers of excellence include the CRF Skirball Center for Innovation, CRF Clinical Trials Center, CRF Center for Education, CRF Digital, TCTMD, and Structural Heart: The Journal of the Heart Team.
Transcatheter Cardiovascular Therapeutics (TCT) is the annual scientific symposium of CRF and the premier educational meeting specializing in interventional cardiovascular medicine. Now in its 34th year, TCT features major medical research breakthroughs and gathers leading researchers and clinicians from around the world to present and discuss the latest evidence-based research in the field.
For more information, visit www.crf.org and www.tctconference.com.
