Use of 64-slice CT in symptomatic patients after coronary bypass surgery: evaluation of grafts and coronary arteries. |
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Authors: | Patrizia Malagutti Koen Nieman Willem B Meijboom Carlos A G van Mieghem Francesca Pugliese Filippo Cademartiri Nico R Mollet Eric Boersma Peter P de Jaegere Pim J de Feyter |
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Institution: | Department of Cardiology, Thorax Centre, Erasmus Medical Center, PO Box 2040, Rotterdam 3000CA, The Netherlands. |
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Abstract: | AIMS: Although previous generations of multislice computed tomography (CT) have demonstrated accurate detection of obstructive bypass graft disease, progression of coronary disease is a more frequent cause for ischaemic symptoms late after bypass graft surgery. We explored the diagnostic performance of 64-slice CT in symptomatic patients after bypass surgery, for the assessment of both grafts and native coronary arteries. METHODS AND RESULTS: The 64-slice CT angiography (Siemens Sensation 64, Germany) was performed in 52 symptomatic patients, 10 +/- 5 years after bypass surgery. Two independent, blinded observers assessed all grafts and coronary arteries for stenosis, using conventional quantitative angiography as a reference. A total of 109 grafts (182 graft segments), 123 distal coronary run-offs, and 116 non-bypassed coronary branches (288 segments) were analysed. Per-segment detection of graft disease yielded a sensitivity of 99% (71/72) and specificity of 96% (106/110). Sensitivity and specificity to detect run-off disease were 89% (8/9) and 93% (106/114), positive predictive value was 50% (8/16). In non-grafted coronary segments, CT detected significant stenosis with a sensitivity and specificity of 97% (62/64) and 86% (192/224). Overestimation occurred more frequently in calcified segments (P = 0.002). CONCLUSION: The 64-slice CT allows angiographic evaluation of grafts and coronary arteries, although overestimation of coronary obstruction occurs, particularly in the presence of calcified disease. |
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Keywords: | Computed tomography Coronary angiography Coronary artery disease Coronary artery bypass surgery Imaging |
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