In patients with prior coronary artery bypass grafting (CABG) undergoing invasive coronary angiography (ICA), the use of computed tomography cardiac angiography (CTCA) improves short term angina status and quality of life, a new trial concludes. Presenting on behalf of the study principal investigator Daniel Jones, MD, Matthew Kelham, MD, detailed how CTCA is able to provide a non-invasive evaluation of the number and location of bypass grafts, and its role in reducing the rate of major cardiac events over a three-year follow up. “In patients with prior CABG, CTCA prior to ICA improves short term angina status and quality of life, with reductions in utilization of imaging resources,” said Kelham, who was presenting Sunday at Cardiovascular Research Technologies (CRT) 2024 in Washington, D.C. “Major cardiac events at 3 years also reduced in CTCA+ICA group. This requires a prospective validation in multicenter randomized controlled trials (RCTs). “[These data are] supportive of routinely undertaking CTCA prior to ICA in patients with prior CABG to improve procedural metrics and outcomes important to patients.” Trial results Results from the 688 patients enrolled onto the Bypass-CTCA trial found that at the 3-month follow-up, patients in the CTCA+ICA group were more likely to be angina-free (51.7% vs 43.2%, P=0.03) compared to the ICA-only group. The research team noted that among patients in the CTCA+ICA group, a greater quality of life was recorded by the health questionnaire (EQ-5D-5L) index (80.6 vs 74.8; P=0.001) along with visual analogue scores (65.1 vs 57.8; P<0.001) – a measure for acute and chronic pain. At the 3-year follow up, imaging resource use (36% vs 45%; odds ratio [OR]=0.7; 95% confidence interval [CI]=0.5-0.9) and incidence of major adverse cardiovascular events (MACE) were lower in the CTCA+ICA group (36% vs 44%; hazard ratio [HR]=0.7; 95% CI=0.6-0.9). After the first year, the incidence of MACE was closer between the groups (22.7% vs. 20.2%) , with incidences higher among patients who had initially presented with acute coronary syndrome (ACS; 44.2% vs. 36.0% in those without ACS). Patients with prior CABG frequently present with further chest pain, for which invasive angiography is the current gold standard investigation, said Kelham, an interventional cardiology registrar and clinical research fellow at Barts Heart Centre in London, where the trial was conducted. However, invasive angiography in CABG patients is more challenging and is associated with increased complications and often further investigations are needed post angiography. CTCA is considered a useful tool in CABG assessment, providing a non-invasive evaluation of the number and location of bypass grafts and being highly accurate at detecting graft stenoses. Methodology A total of 688 patients with prior CABG referred for ICA were randomized 1:1 to undergo CTCA prior to ICA (CTCA+ICA group) or ICA only and then followed up for 3 years. Mean age of participants was 69.8 years, with 45% undergoing ICA for non-ST elevation acute coronary syndromes and the remainder for stable angina. Angina status was assessed using the Seattle Angina Questionnaire and overall quality of life using the health questionnaire EQ-5D-5L. MACE and incidence of non-invasive imaging (CTCA, cardiac magnetic resonance imaging, myocardial perfusion imaging, stress echocardiography) was recorded to three years. The primary outcomes of the Bypass-CTCA trial were decreased procedural duration, decreased kidney injury, and increased patient satisfaction. Photo Credit: Bailey Salimes/CRTonline.org Photo Caption: Matthew Kelham, MD, presents findings from the Bypass-CTCA trial Sunday at CRT 2024 in Washington, D.C.