Kelham Matthew, Beirne Anne-Marie, Rathod Krishnaraj S, Andiapen Mervyn, Wynne Lucinda, Learoyd Annastazia E, Forooghi Nasim, Ramaseshan Rohini, Moon James C, Davies Ceri, Bourantas Christos V, Baumbach Andreas, Manisty Charlotte, Wragg Andrew, Ahluwalia Amrita, Pugliese Francesca, Mathur Anthony, Jones Daniel A
Centre for Cardiovascular Medicine and Devices, Faculty of Medicine and Dentistry, Queen Mary University of London, United Kingdom (M.K., A.-M.B., K.S.R., M.A., L.W., N.F., R.R., A.B., A.A., A.M., D.A.J.).
Barts Interventional Group (M.K., A.-M.B., K.S.R., M.A., L.W., N.F., R.R., C.V.B., A.B., A.W., A.M., D.A.J.), Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom.
Circ Cardiovasc Interv. 2024 Dec;17(12):e014142. doi: 10.1161/CIRCINTERVENTIONS.124.014142. Epub 2024 Nov 25.
In patients with previous coronary artery bypass grafting, computed tomography cardiac angiography (CTCA) before invasive coronary angiography (ICA) was demonstrated in the BYPASS-CTCA trial (Randomized Controlled Trial to Assess Whether Computed Tomography Cardiac Angiography Can Improve Invasive Coronary Angiography in Bypass Surgery Patients) to reduce procedure time and incidence of contrast-associated acute kidney injury, with greater levels of patient satisfaction. Patient-related outcomes, utilization of further diagnostic imaging resources, and longer-term incidence of major adverse cardiac events were key secondary end points not yet reported.
Patients with prior coronary artery bypass grafting referred for ICA were randomized 1:1 to undergo CTCA before ICA or ICA alone and followed up for a median of 3 (2.2-3.4) years. Angina status was assessed using the Seattle Angina Questionnaire and overall quality of life using the EQ-5D-5L. The incidence of noninvasive imaging use and major adverse cardiac events were compared between the 2 groups.
In all, 688 patients were randomized, 344 to CTCA+ICA and 344 to ICA only. The mean age of participants was 69.8 years, with 45% undergoing ICA for acute coronary syndromes and the remainder stable angina. At 3 months follow-up, patients in the CTCA+ICA group were more likely to be angina-free (51.7% versus 43.2%; =0.03) with greater quality of life (EQ-5D-5L index, 81.6 versus 74.4; =0.001), although these improvements did not persist. At 3 years follow-up, imaging resource use (35.8% versus 45.1%; odds ratio, 0.68 [95% CI, 0.50-0.92]; =0.013) and incidence of major adverse cardiac events were lower in the CTCA+ICA group (35.8% versus 43.5%; hazard ratio, 0.73 [95% CI, 0.58-0.93]; =0.010).
In patients with prior coronary artery bypass grafting undergoing ICA, CTCA before ICA leads to reductions in the use of imaging resources and the rate of major cardiac events out to 3 years, but with similar patient-related outcome measures. Together with the initial findings of BYPASS-CTCA, these data are supportive of routinely undertaking a CTCA before ICA in patients with prior coronary artery bypass grafting.
URL: https://www.clinicaltrials.gov; Unique identifier: NCT03736018.
在既往接受过冠状动脉搭桥术的患者中，“旁路CT血管造影试验（BYPASS - CTCA，一项评估计算机断层扫描心脏血管造影能否改善搭桥手术患者有创冠状动脉血管造影的随机对照试验）”表明，在进行有创冠状动脉血管造影（ICA）之前进行计算机断层扫描心脏血管造影（CTCA）可减少手术时间和造影剂相关急性肾损伤的发生率，患者满意度更高。患者相关结局、进一步诊断成像资源的利用情况以及主要不良心脏事件的长期发生率是尚未报告的关键次要终点。
因ICA前来就诊的既往接受过冠状动脉搭桥术的患者按1:1随机分组，一组在ICA前接受CTCA，另一组仅接受ICA，并进行了中位时间为3（2.2 - 3.4）年的随访。使用西雅图心绞痛问卷评估心绞痛状态，使用EQ - 5D - 5L评估总体生活质量。比较两组间无创成像使用情况和主要不良心脏事件的发生率。
总共688例患者被随机分组，344例接受CTCA + ICA，344例仅接受ICA。参与者的平均年龄为69.8岁，45%因急性冠状动脉综合征接受ICA，其余为稳定型心绞痛。在3个月的随访中，CTCA + ICA组的患者更有可能无心绞痛（51.7%对43.2%；P = 0.03），生活质量更高（EQ - 5D - 5L指数，81.6对74.4；P = 0.001），尽管这些改善并未持续。在3年的随访中，CTCA + ICA组的成像资源使用情况（35.8%对45.1%；优势比，0.68 [95% CI，0.50 - 0.92]；P = 0.013）和主要不良心脏事件的发生率较低（35.8%对43.5%；风险比，0.73 [95% CI，0.58 - 0.93]；P = 0.010）。
在既往接受过冠状动脉搭桥术且正在接受ICA的患者中，ICA前进行CTCA可减少成像资源的使用以及3年内主要心脏事件的发生率，但患者相关结局指标相似。连同BYPASS - CTCA的初步研究结果，这些数据支持在既往接受过冠状动脉搭桥术的患者中，在ICA前常规进行CTCA。
