CORRIB Research Centre for Advanced Imaging and Core Lab, University of Galway, University Road, Galway H91 TK33, Ireland.
Centro Cardiologico Monzino, IRCCS, Monzino, Italy.
Eur Heart J. 2024 May 27;45(20):1804-1815. doi: 10.1093/eurheartj/ehae199.
In patients with three-vessel disease and/or left main disease, selecting revascularization strategy based on coronary computed tomography angiography (CCTA) has a high level of virtual agreement with treatment decisions based on invasive coronary angiography (ICA).
In this study, coronary artery bypass grafting (CABG) procedures were planned based on CCTA without knowledge of ICA. The CABG strategy was recommended by a central core laboratory assessing the anatomy and functionality of the coronary circulation. The primary feasibility endpoint was the percentage of operations performed without access to the ICA. The primary safety endpoint was graft patency on 30-day follow-up CCTA. Secondary endpoints included topographical adequacy of grafting, major adverse cardiac and cerebrovascular (MACCE), and major bleeding events at 30 days. The study was considered positive if the lower boundary of confidence intervals (CI) for feasibility was ≥75% (NCT04142021).
The study enrolled 114 patients with a mean (standard deviation) anatomical SYNTAX score and Society of Thoracic Surgery score of 43.6 (15.3) and 0.81 (0.63), respectively. Unblinding ICA was required in one case yielding a feasibility of 99.1% (95% CI 95.2%-100%). The concordance and agreement in revascularization planning between the ICA- and CCTA-Heart Teams was 82.9% with a moderate kappa of 0.58 (95% CI 0.50-0.66) and between the CCTA-Heart Team and actual treatment was 83.7% with a substantial kappa of 0.61 (95% CI 0.53-0.68). The 30-day follow-up CCTA in 102 patients (91.9%) showed an anastomosis patency rate of 92.6%, whilst MACCE was 7.2% and major bleeding 2.7%.
CABG guided by CCTA is feasible and has an acceptable safety profile in a selected population of complex coronary artery disease.
对于三支血管病变和/或左主干病变的患者，基于冠状动脉计算机断层扫描血管造影（CCTA）选择血运重建策略与基于有创冠状动脉造影（ICA）的治疗决策具有高度的虚拟一致性。
在这项研究中，冠状动脉旁路移植术（CABG）是基于 CCTA 而不了解 ICA 来计划的。CABG 策略由一个中心核心实验室评估冠状动脉循环的解剖结构和功能来推荐。主要可行性终点是无需进行 ICA 即可进行手术的比例。主要安全性终点是 30 天随访 CCTA 时的桥血管通畅率。次要终点包括移植物的拓扑学充足性、主要心脏和脑血管不良事件（MACCE）以及 30 天时的主要出血事件。如果置信区间（CI）下限的可行性≥75%（NCT04142021），则研究被认为是阳性。
这项研究纳入了 114 名患者，平均（标准差）解剖学 SYNTAX 评分和胸外科评分分别为 43.6（15.3）和 0.81（0.63）。在 1 例病例中需要揭开 ICA 的蒙布，其可行性为 99.1%（95%CI 95.2%-100%）。ICA-和 CCTA-心脏团队之间的血运重建计划的一致性和一致性为 82.9%，kappa 值为 0.58（95%CI 0.50-0.66），CCTA-心脏团队和实际治疗之间的一致性为 83.7%，kappa 值为 0.61（95%CI 0.53-0.68）。在 102 名患者（91.9%）的 30 天随访 CCTA 中，吻合口通畅率为 92.6%，而 MACCE 为 7.2%，主要出血为 2.7%。
在选择的复杂冠状动脉疾病患者人群中，基于 CCTA 的 CABG 是可行的，且具有可接受的安全性。
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