Can a Noninvasive CT Scan Prior to Invasive Coronary Angiography Improve Procedural Outcomes in Patients With Prior Coronary Artery Bypass Grafting - BYPASS-CTCA

Oct 10, 2023
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Author/Summarized by Author:
Anthony A. Bavry, MD,MPH,FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC; Kim A. Eagle, MD, MACC
Trial Sponsor:
National Institute for Health Research
Date Presented:
09/19/2022
Date Published:
09/19/2022
Date Updated:
10/10/2023
Original Posted Date:
09/19/2022
References

Contribution To Literature:

Highlighted text has been updated as of October 10, 2023.

The BYPASS-CTCA trial showed that a noninvasive CT scan prior to invasive coronary angiography reduces procedure duration and contrast-induced nephropathy, and improves patient satisfaction.

Description:

The goal of the trial was to evaluate if a noninvasive computed tomography (CT) scan prior to invasive coronary angiography improves procedural outcomes in patients with prior coronary artery bypass grafting (CABG).

Study Design

  • Randomized
  • Parallel

Patients with prior CABG requiring invasive coronary angiography were randomized to noninvasive CT (n = 344) scan versus control (n = 344).

  • Total number of enrollees: 688
  • Duration of follow-up: 12 months
  • Mean patient age: 69 years
  • Percentage female: 16%
  • Percentage with diabetes: 54%

Inclusion criteria:

  • Patients ≥18 years of age with prior CABG requiring invasive coronary angiography
  • Stable angina and non–ST-segment elevation acute coronary syndrome

Exclusion criteria:

  • ST-segment elevation myocardial infarction
  • Hemodynamic or clinical instability
  • Severe renal insufficiency
  • Current life-threatening condition
  • Pregnancy
  • Inability to tolerate beta-blocker
  • Contrast allergy

Principal Findings:

  • Procedure duration: 18.6 minutes in the noninvasive CT scan group vs. 39.5 minutes in the control group (p < 0.001)
  • Contrast-induced nephropathy: 3.4% in the noninvasive CT scan group vs. 27.9% in the control group (p < 0.001)
  • Patient satisfaction score (lower score correlates with very good): 1.49 in the noninvasive CT scan group vs. 2.54 in the control group

Secondary outcomes:

  • Procedural complications, defined as myocardial infarction, stroke, or bleeding: 2.3% in the noninvasive CT scan group vs. 10.8% in the control group (p < 0.001)

Interpretation:

Among patients with prior CABG requiring invasive coronary angiography, a pre-procedure noninvasive CT scan was beneficial. A noninvasive CT scan was associated with a reduction in procedure duration, reduction in contrast-induced nephropathy, and improvement in patient satisfaction. A noninvasive CT scan was also associated with a reduction in procedural complications.

References:

Jones DA, Beirne A, Kelham M, et al., on behalf of the BYPASS-CTCA Trial Committees and Investigators. Computed Tomography Cardiac Angiography Before Invasive Coronary Angiography in Patients With Previous Bypass Surgery: The BYPASS-CTCA Trial. Circulation 2023;Sep 29:[Epub ahead of print].

Presented by Dr. Daniel A. Jones at the Transcatheter Cardiovascular Therapeutics meeting (TCT 2022), Boston, MA, September 19, 2022.

Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Cardiac Surgery and SIHD, Interventions and ACS, Interventions and Imaging, Angiography, Computed Tomography, Nuclear Imaging

Keywords: Acute Coronary Syndrome, Angina Pectoris, Cardiac Surgical Procedures, Coronary Angiography, Coronary Artery Bypass, Diagnostic Imaging, Hemorrhage, Myocardial Infarction, Patient Satisfaction, Stroke, TCT22, Tomography, Tomography, X-Ray Computed, Transcatheter Cardiovascular Therapeutics


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