Generic placeholder image

Current Medical Imaging

Editor-in-Chief

ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

Research Article

Graft Patency Assessment with CCTA Using a Comprehensive Singlebranch Bridging Score

Author(s): Zengfa Huang, Yang Yang, Xinyu Du, Xi Wang, Zuoqin Li, Yun Hu, Xiang Li, Jianwei Xiao* and Xiang Wang*

Volume 19, Issue 7, 2023

Published on: 03 November, 2022

Article ID: e141022210035 Pages: 7

DOI: 10.2174/1573405619666221014122749

Price: $65

Abstract

Aims: This study aims to assess the prognostic value of graft patency with coronary computed tomography angiography (CCTA) using a comprehensive single-branch targeted atherosclerotic risk score (CSBS) in patients before coronary artery bypass grafting (CABG).

Methods: This retrospective study contains a total of 88 patients who underwent clinical CCTA before off-pump CABG surgery between 2015 and 2018. Graft failure was defined as patients with missing multi-slice CCTA or coronary angiography. The predictive value of CSBS (ranging from 0-70 and divided into 2 groups: < 20 and ≥20) was analyzed using Kaplan–Meier analysis and Cox regression models.

Results: Patients' mean age was 61.2 ± 10.5 years, with a mean follow-up of 20.4 ± 15.2 months. A total of 203 grafts (21.5% arterial grafts) were analyzed and 30 of the vessels were occluded (14.8%). There was no significant difference in graft occlusion among the three targeted vessel groups. The Cox proportional hazard analysis showed that CSBS < 20 was a significant predictor of graft failure.

Conclusion: Lower comprehensive single-branch targeted atherosclerotic risk score evaluated by CCTA is an independent prognostic factor for graft failure in patients before CABG surgery.

Graphical Abstract

[1]
Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J 2019; 40(2): 87-165.
[http://dx.doi.org/10.1093/eurheartj/ehy394] [PMID: 30165437]
[2]
de Vries MR, Simons KH, Jukema JW, Braun J, Quax PHA. Vein graft failure: From pathophysiology to clinical outcomes. Nat Rev Cardiol 2016; 13(8): 451-70.
[http://dx.doi.org/10.1038/nrcardio.2016.76] [PMID: 27194091]
[3]
Gaudino M, Antoniades C, Benedetto U, et al. Mechanisms, consequences, and prevention of coronary graft failure. Circulation 2017; 136(18): 1749-64.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.117.027597] [PMID: 29084780]
[4]
Knuuti J, Ballo H, Juarez-Orozco LE, et al. The performance of non-invasive tests to rule-in and rule-out significant coronary artery stenosis in patients with stable angina: A meta-analysis focused on post-test disease probability. Eur Heart J 2018; 39(35): 3322-30.
[http://dx.doi.org/10.1093/eurheartj/ehy267] [PMID: 29850808]
[5]
Small GR, Yam Y, Chen L, et al. Prognostic assessment of coronary artery bypass patients with 64-slice computed tomography angiography: Anatomical information is incremental to clinical risk prediction. J Am Coll Cardiol 2011; 58(23): 2389-95.
[http://dx.doi.org/10.1016/j.jacc.2011.08.047] [PMID: 22115645]
[6]
Campbell PG, Teo KSL, Worthley SG, et al. Non-invasive assessment of saphenous vein graft patency in asymptomatic patients. Br J Radiol 2009; 82(976): 291-5.
[http://dx.doi.org/10.1259/bjr/19829466] [PMID: 19325046]
[7]
Versteylen MO, Joosen IA, Winkens MH, et al. Combined use of exercise electrocardiography, coronary calcium score and cardiac CT angiography for the prediction of major cardiovascular events in patients presenting with stable chest pain. Int J Cardiol 2013; 167(1): 121-5.
[http://dx.doi.org/10.1016/j.ijcard.2011.12.016] [PMID: 22225760]
[8]
Nielsen LH, Bøtker HE, Sørensen HT, et al. Prognostic assessment of stable coronary artery disease as determined by coronary computed tomography angiography: A Danish multicentre cohort study. Eur Heart J 2017; 38(6): 413-21.
[PMID: 27941018]
[9]
Shaw LJ, Hausleiter J, Achenbach S, et al. Coronary computed tomographic angiography as a gatekeeper to invasive diagnostic and surgical procedures: Results from the multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry. J Am Coll Cardiol 2012; 60(20): 2103-14.
[http://dx.doi.org/10.1016/j.jacc.2012.05.062] [PMID: 23083780]
[10]
van Rosendael AR, Shaw LJ, Xie JX, et al. Superior risk stratification with coronary computed tomography angiography using a comprehensive atherosclerotic risk score. JACC Cardiovasc Imaging 2019; 12(10): 1987-97.
[11]
Huang Z, Xiao J, Wang X, et al. Clinical evaluation of the automatic coronary artery disease reporting and data system (CAD-RADS) in coronary computed tomography angiography using convolutional neural networks. Acad Radiol 2022; S1076-6332(22): 00318-X.
[http://dx.doi.org/10.1016/j.acra.2022.05.015] [PMID: 35753936]
[12]
Huang Z, Zhang S, Jin N, et al. Prognostic value of CAD-RADS classification by coronary CTA in patients with suspected CAD. BMC Cardiovasc Disord 2021; 21(1): 476.
[http://dx.doi.org/10.1186/s12872-021-02286-x] [PMID: 34602055]
[13]
Huang Z, Xiao J, Xie Y, et al. The correlation of deep learning-based CAD-RADS evaluated by coronary computed tomography angiography with breast arterial calcification on mammography. Sci Rep 2020; 10(1): 11532.
[http://dx.doi.org/10.1038/s41598-020-68378-4] [PMID: 32661231]
[14]
Huang Z, Xiao J, Li Z, et al. Evaluation of LVDD by CCTA with dual-source CT in type 2 diabetes mellitus patients. Curr Med Imag 2020; 16(3): 214-23.
[15]
Leipsic J, Abbara S, Achenbach S, et al. SCCT guidelines for the interpretation and reporting of coronary CT angiography: A report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr 2014; 8(5): 342-58.
[http://dx.doi.org/10.1016/j.jcct.2014.07.003] [PMID: 25301040]
[16]
Hadamitzky M, Achenbach S, Al-Mallah M, et al. Optimized prognostic score for coronary computed tomographic angiography: Results from the CONFIRM registry (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter Registry). J Am Coll Cardiol 2013; 62(5): 468-76.
[http://dx.doi.org/10.1016/j.jacc.2013.04.064] [PMID: 23727215]
[17]
Leaman DM, Brower RW, Meester GT, Serruys P, van den Brand M. Coronary artery atherosclerosis: Severity of the disease, severity of angina pectoris and compromised left ventricular function. Circulation 1981; 63(2): 285-99.
[http://dx.doi.org/10.1161/01.CIR.63.2.285] [PMID: 7449052]
[18]
van Werkhoven JM, Schuijf JD, Gaemperli O, et al. Incremental prognostic value of multi-slice computed tomography coronary angiography over coronary artery calcium scoring in patients with suspected coronary artery disease. Eur Heart J 2009; 30(21): 2622-9.
[http://dx.doi.org/10.1093/eurheartj/ehp272] [PMID: 19567382]
[19]
Hicks KA, Tcheng JE, Bozkurt B, et al. 2014 ACC/AHA key data elements and definitions for cardiovascular endpoint events in clinical trials. J Am Coll Cardiol 2015; 66(4): 403-69.
[http://dx.doi.org/10.1016/j.jacc.2014.12.018] [PMID: 25553722]
[20]
Zhang K, Wang J, Yang Y, An R. Adiposity in relation to readmission and all‐cause mortality following coronary artery bypass grafting: A systematic review and meta‐analysis. Obes Rev 2019; 20(8): obr.12855.
[http://dx.doi.org/10.1111/obr.12855] [PMID: 30945439]
[21]
Fitzgibbon GM, Kafka HP, Leach AJ, Keon WJ, Hooper GD, Burton JR. Coronary bypass graft fate and patient outcome: Angiographic follow-up of 5,065 grafts related to survival and reoperation in 1,388 patients during 25 years. J Am Coll Cardiol 1996; 28(3): 616-26.
[http://dx.doi.org/10.1016/0735-1097(96)00206-9] [PMID: 8772748]
[22]
Deb S, Cohen EA, Singh SK, et al. Radial artery and saphenous vein patency more than 5 years after coronary artery bypass surgery: Results from RAPS (Radial Artery Patency Study). J Am Coll Cardiol 2012; 60(1): 28-35.
[http://dx.doi.org/10.1016/j.jacc.2012.03.037] [PMID: 22742399]
[23]
Goldman S, Zadina K, Moritz T, et al. Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery. J Am Coll Cardiol 2004; 44(11): 2149-56.
[http://dx.doi.org/10.1016/j.jacc.2004.08.064] [PMID: 15582312]
[24]
Berger A, MacCarthy PA, Siebert U, et al. Long-term patency of internal mammary artery bypass grafts: Relationship with preoperative severity of the native coronary artery stenosis. Circulation 2004; 110 (Suppl. 1): II36-40.
[http://dx.doi.org/10.1161/01.CIR.0000141256.05740.69] [PMID: 15364835]
[25]
Nasu M, Akasaka T, Okazaki T, et al. Postoperative flow characteristics of left internal thoracic artery grafts. Ann Thorac Surg 1995; 59(1): 154-62.
[http://dx.doi.org/10.1016/0003-4975(94)00795-9] [PMID: 7818315]
[26]
Chan M, Ridley L, Dunn DJ, et al. A systematic review and meta-analysis of multidetector computed tomography in the assessment of coronary artery bypass grafts. Int J Cardiol 2016; 221: 898-905.
[http://dx.doi.org/10.1016/j.ijcard.2016.06.264] [PMID: 27439070]
[27]
Kulik A, Ruel M. Statins and coronary artery bypass graft surgery: Preoperative and postoperative efficacy and safety. Expert Opin Drug Saf 2009; 8(5): 559-71.
[http://dx.doi.org/10.1517/14740330903188413] [PMID: 19673591]
[28]
Christenson J. Preoperative lipid control with simvastatin reduces the risk for graft failure already 1 year after myocardial revascularization. Cardiovasc Surg 2001; 9(1): 33-43.
[http://dx.doi.org/10.1016/S0967-2109(00)00088-0] [PMID: 11137806]
[29]
Efird JT, O’Neal WT, Gouge CA, et al. Implications of hemodialysis in patients undergoing coronary artery bypass grafting. Int J Cardiovasc Res 2013; 2(6)1000154
[http://dx.doi.org/10.4172/2324-8602.1000154] [PMID: 25309935]
[30]
Yanagawa B, Algarni KD, Singh SK, et al. Clinical, biochemical, and genetic predictors of coronary artery bypass graft failure. J Thorac Cardiovasc Surg 2014; 148(2): 515-520.e2.
[http://dx.doi.org/10.1016/j.jtcvs.2013.10.011] [PMID: 24332189]
[31]
Conte MS, Bandyk DF, Clowes AW, Moneta GL, Namini H, Seely L. Risk factors, medical therapies and perioperative events in limb salvage surgery: Observations from the PREVENT III multicenter trial. J Vasc Surg 2005; 42(3): 456-64.
[http://dx.doi.org/10.1016/j.jvs.2005.05.001] [PMID: 16171587]
[32]
Monahan TS, Owens CD. Risk factors for lower-extremity vein graft failure. Semin Vasc Surg 2009; 22(4): 216-26.
[http://dx.doi.org/10.1053/j.semvascsurg.2009.10.003] [PMID: 20006801]
[33]
Owens CD, Ho KJ, Conte MS. Risk factors for failure of lower-extremity revascularization procedures: Are they different for bypass and percutaneous procedures? Semin Vasc Surg 2008; 21(3): 143-53.
[http://dx.doi.org/10.1053/j.semvascsurg.2008.05.007] [PMID: 18774450]
[34]
Harskamp RE, Alexander JH, Ferguson TB Jr, et al. Frequency and predictors of internal mammary artery graft failure and subsequent clinical outcomes. Circulation 2016; 133(2): 131-8.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.115.015549] [PMID: 26647082]
[35]
Raza S, Blackstone EH, Houghtaling PL, et al. Influence of diabetes on long-term coronary artery bypass graft patency. J Am Coll Cardiol 2017; 70(5): 515-24.
[http://dx.doi.org/10.1016/j.jacc.2017.05.061] [PMID: 28750693]
[36]
Desai ND, Naylor CD, Kiss A, et al. Impact of patient and target-vessel characteristics on arterial and venous bypass graft patency: Insight from a randomized trial. Circulation 2007; 115(6): 684-91.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.105.567495] [PMID: 17283268]
[37]
Sabik JF III, Lytle BW, Blackstone EH, Khan M, Houghtaling PL, Cosgrove DM. Does competitive flow reduce internal thoracic artery graft patency? Ann Thorac Surg 2003; 76(5): 1490-7.
[http://dx.doi.org/10.1016/S0003-4975(03)01022-1] [PMID: 14602274]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy