The benefit of 64-MDCT prior to invasive coronary angiography in symptomatic post-CABG patients.
OBJECTIVE
The purpose of this study is to assess the diagnostic accuracy of 64-MDCT in symptomatic patients after CABG and to explore the advantages of the 64-MDCT results on the CAG procedure.


METHODS
From December 2004 until August 2005, 34 post-CABG patients (29 men, mean age 63.5 +/- 8.5 years) with 69 coronary artery bypass grafts were scanned on a 64-MDCT (Somatom Sensation 64, Siemens AG, Forchheim, Germany) prior to CAG. Angiograms and 64-MDCT images were evaluated for the existence of occlusions or significant stenosis (>or=50% lumen reduction) in bypass grafts and native coronary arteries.


RESULTS
64-MDCT had a sensitivity, a specificity, and a diagnostic accuracy of 100% for occlusion detection. For stenosis detection, sensitivity was 100%, specificity 98.7% and diagnostic accuracy 98.7%. For detecting significant stenosis in native coronary arteries, 64-MDCT had a sensitivity of 80.0%, specificity of 90.8%, and a diagnostic accuracy of 87.1%. Seventeen patients (50.0%) did not need invasive treatment, 14 patients (41.2%) underwent a percutaneous coronary intervention (PCI), and 3 patients (8.8%) underwent surgery. Treatment advice based on 64-MDCT was correct in 88.2% of patients and when 64-MDCT results would have been known 58.8% of diagnostic CAG procedures could have been prevented.


CONCLUSIONS
In conclusion, 64-MDCT has a high diagnostic accuracy in detecting bypass graft stenosis and occlusions, and 64-MDCT based treatment advice was correct in 88.2% of patients.
Dikkers
R
R
Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30001, 9700 RB, Groningen, The Netherlands. r.dikkers@rad.umcg.nl
Willems
T P
TP
Tio
R A
RA
Anthonio
R L
RL
Zijlstra
F
F
Oudkerk
M
M
D000368:Aged; D003287:Contrast Media; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000601:surgery; D023903:Coronary Restenosis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007479:Iopamidol / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012008:Recurrence; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol