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
Font Size
A
A
A
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, Cardiovascular Care Team, 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


< Back to Listings