The benefit of 64-MDCT prior to invasive coronary angiography in symptomatic post-CABG patients

  • R. Dikkers
  • T. P. Willems
  • R. A. Tio
  • R. L. Anthonio
  • F. Zijlstra
  • M. Oudkerk
Original Paper

Abstract

Purpose

The purpose of this study is to assess the diagnostic accuracy of 64-MDCT in symptomatic patients after CABG and to explore the advantages of the 64-MDCT results on the CAG procedure.

Material and methods

From December 2004 until August 2005, 34 post-CABG patients (29 men, mean age 63.5 ± 8.5 years) with 69 coronary artery bypass grafts were scanned on a 64-MDCT (Somatom Sensation 64, Siemens AG, Forchheim, Germany) prior to CAG. Angiograms and 64-MDCT images were evaluated for the existence of occlusions or significant stenosis (≥50% lumen reduction) in bypass grafts and native coronary arteries.

Results

64-MDCT had a sensitivity, a specificity, and a diagnostic accuracy of 100% for occlusion detection. For stenosis detection, sensitivity was 100%, specificity 98.7% and diagnostic accuracy 98.7%. For detecting significant stenosis in native coronary arteries, 64-MDCT had a sensitivity of 80.0%, specificity of 90.8%, and a diagnostic accuracy of 87.1%.

Seventeen patients (50.0%) did not need invasive treatment, 14 patients (41.2%) underwent a percutaneous coronary intervention (PCI), and 3 patients (8.8%) underwent surgery. Treatment advice based on 64-MDCT was correct in 88.2% of patients and when 64-MDCT results would have been known 58.8% of diagnostic CAG procedures could have been prevented.

Conclusion

In conclusion, 64-MDCT has a high diagnostic accuracy in detecting bypass graft stenosis and occlusions, and 64-MDCT based treatment advice was correct in 88.2% of patients.

Keywords

Computed tomography Coronary artery bypass Coronary disease 

Abbreviations

CAG

coronary angiography

GDA

gastroduodenal artery

GEA

gastroepiploic artery

LAD

left anterior descending artery

LCx

left circumflex artery

LIMA

left internal mammary artery

LM

left main

MDCT

multidetector computed tomography

PCI

percutaneous intervention procedure

RCA

right coronary artery

RIMA

right internal mammary artery

SD

standard deviation

Notes

Acknowledgements

The authors thank Dr. EJK Noach for her assistance in the preparation of the manuscript and WGJ Tukker for his technical advice.

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Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • R. Dikkers
    • 1
  • T. P. Willems
    • 1
  • R. A. Tio
    • 2
  • R. L. Anthonio
    • 2
  • F. Zijlstra
    • 2
  • M. Oudkerk
    • 1
  1. 1.Department of RadiologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
  2. 2.Department of CardiologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands

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