The benefit of 64-MDCT prior to invasive coronary angiography in symptomatic post-CABG patients
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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.
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.
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.
KeywordsComputed tomography Coronary artery bypass Coronary disease
left anterior descending artery
left circumflex artery
left internal mammary artery
multidetector computed tomography
percutaneous intervention procedure
right coronary artery
right internal mammary artery
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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