title: Prognostic assessment of coronary artery bypass patients with 64-slice computed tomography angiography: anatomical information is incremental to clinical risk prediction.
abstract: OBJECTIVE
  We sought to determine the incremental prognostic value of 64 multi-slice coronary computed tomography angiography (CCTA) in coronary artery bypass graft (CABG) patients.
  
  
  BACKGROUND
  Prognostication in CABG patients can be difficult. Anatomical assessment of native coronary artery disease and graft patency might provide useful information, but the utility of CCTA in the assessment of CABG patients is unknown.
  
  
  METHODS
  Six hundred fifty-seven CABG patients with all-cause mortality follow-up were identified from a multicenter CCTA registry, of 10,628 patients from 5 CCTA centers. Clinical risk was profiled with modified logistic and additive EuroSCOREs (European Systems for Cardiac Operative Risk Evaluations). The CCTA defined coronary anatomy. Patients were classified by unprotected coronary territory (UCT) or a summary of native vessel disease and graft patency: the coronary artery protection score (CAPS).
  
  
  RESULTS
  Forty-four deaths occurred during a mean follow-up of 20 months. Left ventricular ejection fraction, creatinine, age, severity of native vessel disease, UCT, CAPS, and EuroSCOREs were univariate predictors of mortality (p < 0.001). In multivariate analysis with additive EuroSCORE, UCT (p = 0.004) and CAPS were predictive of events (p < 0.001). In comparison with additive EuroSCORE, CAPS score was associated with a 27% net reclassification index.
  
  
  CONCLUSIONS
  Coronary computed tomography angiography provides incremental anatomical data to clinical risk assessment to help determine the prognosis of patients after CABG. The CAPS evaluation with CCTA might help identify those patients at highest risk.
authors: Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors: Gary R
authors: GR
authors: Small
authors: Yeung
authors: Y
authors: Yam
authors: Li
authors: L
authors: Chen
authors: Osman
authors: O
authors: Ahmed
authors: Mouaz
authors: M
authors: Al-Mallah
authors: Daniel S
authors: DS
authors: Berman
authors: Victor Y
authors: VY
authors: Cheng
authors: Kavitha
authors: K
authors: Chinnaiyan
authors: Gilbert
authors: G
authors: Raff
authors: Todd C
authors: TC
authors: Villines
authors: Stephan
authors: S
authors: Achenbach
authors: Matthew J
authors: MJ
authors: Budoff
authors: Filippo
authors: F
authors: Cademartiri
authors: Tracy Q
authors: TQ
authors: Callister
authors: Hyuk-Jae
authors: HJ
authors: Chang
authors: Augustin
authors: A
authors: Delago
authors: Allison
authors: A
authors: Dunning
authors: Martin
authors: M
authors: Hadamitzky
authors: Jorg
authors: J
authors: Hausleiter
authors: Philipp
authors: P
authors: Kaufmann
authors: Fay
authors: F
authors: Lin
authors: Erica
authors: E
authors: Maffei
authors: James K
authors: JK
authors: Min
authors: Leslee J
authors: LJ
authors: Shaw
authors: Benjamin J W
authors: BJ
authors: Chow
mesh_terms: D000368:Aged; D002423:Cause of Death; D017023:Coronary Angiography / Q000379:methods*; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D014943:Global Health; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000379:methods*