title: A systematic review and meta-analysis of multidetector computed tomography in the assessment of coronary artery bypass grafts.
abstract: OBJECTIVE
  The present meta-analysis aimed to compare the diagnostic accuracy of more recent computed tomography coronary angiography (CTCA) with invasive coronary angiography (ICA) in the assessment of graft patency after coronary artery bypass graft surgery (CABG).
  
  
  METHODS
  A systematic review was performed using nine electronic databases from their dates of inception to July 2015. Predefined inclusion criteria included studies reporting on comparative outcomes using ≥64 slice multidetector computed tomography (MDCT) and ICA. The primary endpoints included graft occlusion and significant graft stenosis ≥50%. Secondary analyses included the comparison of arterial versus venous graft conduits, and the use of different MDCT techniques.
  
  
  RESULTS
  Thirty-one studies were identified according to selection criteria, involving 1975 patients with 5364 assessed grafts. Combined assessment of stenosis and occlusion for all grafts demonstrated a sensitivity of 96.1% [95% confidence interval (CI) 94.3-97.4%] and specificity of 96.3% (95% CI 95.1-97.3%). CTCA assessment of venous grafts demonstrated higher sensitivity compared to arterial grafts, when testing for both occlusion and stenosis (97.6% vs 89.2%, p=0.004).
  
  
  CONCLUSIONS
  Results of this study demonstrated that CTCA had a relatively high pooled sensitivity, specificity and negative predictive value compared to ICA. However, patient baseline characteristics varied between studies, and the results should be interpreted with caution. Nonetheless, our results indicate that CTCA should be recognized as an accurate and non-invasive investigation for graft patency in symptomatic patients after CABG.
authors.affiliation: Department of Radiology, Concord Repatriation and General Hospital, Sydney, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Chan
authors.affiliation: Department of Radiology, Concord Repatriation and General Hospital, Sydney, Australia.
authors.forename: Lloyd
authors.initials: L
authors.lastname: Ridley
authors.affiliation: The University of Sydney, Sydney, Australia.
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Dunn
authors.affiliation: The Collaborative Research Group, Macquarie University, Sydney, Australia.
authors.forename: David H
authors.initials: DH
authors.lastname: Tian
authors.affiliation: The Collaborative Research Group, Macquarie University, Sydney, Australia.
authors.forename: Kevin
authors.initials: K
authors.lastname: Liou
authors.affiliation: The Collaborative Research Group, Macquarie University, Sydney, Australia.
authors.forename: Jessica
authors.initials: J
authors.lastname: Ozdirik
authors.affiliation: Department of Cardiology, Prince of Wales Hospital, Sydney, Australia.
authors.forename: Chaitu
authors.initials: C
authors.lastname: Cheruvu
authors.affiliation: The Collaborative Research Group, Macquarie University, Sydney, Australia. Electronic address: drchriscao@gmail.com.
authors.forename: Christopher
authors.initials: C
authors.lastname: Cao
mesh_terms: D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000639:trends*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006801:Humans; D061330:Multidetector Computed Tomography / Q000379:methods / Q000639:trends*; D064887:Observational Studies as Topic / Q000379:methods
keywords: CT coronary angiography; Coronary artery bypass graft surgery; Invasive coronary angiography; Meta-analysis