Computed Tomography Cardiac Angiography Before Invasive Coronary Angiography in Patients With Previous Bypass Surgery: The BYPASS-CTCA Trial.

Aged Aged, 80 and over Female Humans Male Middle Aged Computed Tomography Angiography Coronary Angiography / adverse effects Coronary Artery Disease / diagnostic imaging Coronary Artery Bypass
coronary angiography coronary artery bypass myocardial ischemia

Journal

Circulation
ISSN: 1524-4539
Titre abrégé: Circulation
Pays: United States
ID NLM: 0147763

Informations de publication

Date de publication:
31 10 2023
Historique:
medline: 2 11 2023
pubmed: 29 9 2023
entrez: 29 9 2023
Statut: ppublish

Résumé

Patients with previous coronary artery bypass grafting often require invasive coronary angiography (ICA). However, for these patients, the procedure is technically more challenging and has a higher risk of complications. Observational studies suggest that computed tomography cardiac angiography (CTCA) may facilitate ICA in this group, but this has not been tested in a randomized controlled trial. This study was a single-center, open-label randomized controlled trial assessing the benefit of adjunctive CTCA in patients with previous coronary artery bypass grafting referred for ICA. Patients were randomized 1:1 to undergo CTCA before ICA or ICA alone. The co-primary end points were procedural duration of the ICA (defined as the interval between local anesthesia administration for obtaining vascular access and removal of the last catheter), patient satisfaction after ICA using a validated questionnaire, and the incidence of contrast-induced nephropathy. Linear regression was used for procedural duration and patient satisfaction score; contrast-induced nephropathy was analyzed using logistic regression. We applied the Bonferroni correction, with Over 3 years, 688 patients were randomized with a median follow-up of 1.0 years. The mean age was 69.8±10.4 years, 108 (15.7%) were women, 402 (58.4%) were White, and there was a high burden of comorbidity (85.3% hypertension and 53.8% diabetes). The median time from coronary artery bypass grafting to angiography was 12.0 years, and there were a median of 3 (interquartile range, 2 to 3) grafts per participant. Procedure duration of the ICA was significantly shorter in the CTCA+ICA group (CTCA+ICA, 18.6±9.5 minutes versus ICA alone, 39.5±16.9 minutes [98.33% CI, -23.5 to -18.4]; For patients with previous coronary artery bypass grafting, CTCA before ICA leads to reductions in procedure time and contrast-induced nephropathy, with improved patient satisfaction. CTCA before ICA should be considered in this group of patients. URL: https://www. gov; Unique identifier: NCT03736018.

Sections du résumé

BACKGROUND
Patients with previous coronary artery bypass grafting often require invasive coronary angiography (ICA). However, for these patients, the procedure is technically more challenging and has a higher risk of complications. Observational studies suggest that computed tomography cardiac angiography (CTCA) may facilitate ICA in this group, but this has not been tested in a randomized controlled trial.
METHODS
This study was a single-center, open-label randomized controlled trial assessing the benefit of adjunctive CTCA in patients with previous coronary artery bypass grafting referred for ICA. Patients were randomized 1:1 to undergo CTCA before ICA or ICA alone. The co-primary end points were procedural duration of the ICA (defined as the interval between local anesthesia administration for obtaining vascular access and removal of the last catheter), patient satisfaction after ICA using a validated questionnaire, and the incidence of contrast-induced nephropathy. Linear regression was used for procedural duration and patient satisfaction score; contrast-induced nephropathy was analyzed using logistic regression. We applied the Bonferroni correction, with
RESULTS
Over 3 years, 688 patients were randomized with a median follow-up of 1.0 years. The mean age was 69.8±10.4 years, 108 (15.7%) were women, 402 (58.4%) were White, and there was a high burden of comorbidity (85.3% hypertension and 53.8% diabetes). The median time from coronary artery bypass grafting to angiography was 12.0 years, and there were a median of 3 (interquartile range, 2 to 3) grafts per participant. Procedure duration of the ICA was significantly shorter in the CTCA+ICA group (CTCA+ICA, 18.6±9.5 minutes versus ICA alone, 39.5±16.9 minutes [98.33% CI, -23.5 to -18.4];
CONCLUSIONS
For patients with previous coronary artery bypass grafting, CTCA before ICA leads to reductions in procedure time and contrast-induced nephropathy, with improved patient satisfaction. CTCA before ICA should be considered in this group of patients.
REGISTRATION
URL: https://www.
CLINICALTRIALS
gov; Unique identifier: NCT03736018.

Identifiants

DOI: 10.1161/CIRCULATIONAHA.123.064465 PMID: 37772419
pubmed: 37772419
doi: 10.1161/CIRCULATIONAHA.123.064465
doi:

Banques de données

ClinicalTrials.gov
['NCT03736018']

Types de publication

Journal Article Randomized Controlled Trial Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

1371-1380

Subventions

Organisme : Department of Health
ID : PB-PG-1216-20028
Pays : United Kingdom

Auteurs

Daniel A Jones (DA)

Centre for Cardiovascular Medicine and Devices (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., A.B., A.A., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
Barts Cardiovascular Clinical Trials Unit (D.A.J., T.G., A.B., A.A.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
Queen Mary University of London, UK. Barts Interventional Group (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., C.V.B., A.B., A.W., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
ORCID: 0000-0003-1441-0417

Anne-Marie Beirne (AM)

Centre for Cardiovascular Medicine and Devices (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., A.B., A.A., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
Queen Mary University of London, UK. Barts Interventional Group (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., C.V.B., A.B., A.W., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK.

Matthew Kelham (M)

Centre for Cardiovascular Medicine and Devices (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., A.B., A.A., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
Queen Mary University of London, UK. Barts Interventional Group (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., C.V.B., A.B., A.W., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
ORCID: 0000-0002-4118-5043

Krishnaraj S Rathod (KS)

Centre for Cardiovascular Medicine and Devices (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., A.B., A.A., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK.

Mervyn Andiapen (M)

Centre for Cardiovascular Medicine and Devices (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., A.B., A.A., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
Queen Mary University of London, UK. Barts Interventional Group (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., C.V.B., A.B., A.W., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
ORCID: 0000-0002-1796-0214

Lucinda Wynne (L)

Centre for Cardiovascular Medicine and Devices (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., A.B., A.A., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
Queen Mary University of London, UK. Barts Interventional Group (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., C.V.B., A.B., A.W., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
ORCID: 0000-0002-9737-9293

Thomas Godec (T)

Barts Cardiovascular Clinical Trials Unit (D.A.J., T.G., A.B., A.A.), Barts Heart Centre, Barts Health NHS Trust, London, UK.

Nasim Forooghi (N)

Centre for Cardiovascular Medicine and Devices (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., A.B., A.A., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
Queen Mary University of London, UK. Barts Interventional Group (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., C.V.B., A.B., A.W., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
ORCID: 0000-0002-4010-9284

Rohini Ramaseshan (R)

Centre for Cardiovascular Medicine and Devices (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., A.B., A.A., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
Queen Mary University of London, UK. Barts Interventional Group (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., C.V.B., A.B., A.W., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
ORCID: 0000-0002-2374-0779

James C Moon (JC)

Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
Department of Cardiac Imaging (J.C.M., C.D., C.M., F.P.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
ORCID: 0000-0001-8071-1491

Ceri Davies (C)

Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
Department of Cardiac Imaging (J.C.M., C.D., C.M., F.P.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
ORCID: 0000-0001-7239-2996

Christos V Bourantas (CV)

Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
Queen Mary University of London, UK. Barts Interventional Group (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., C.V.B., A.B., A.W., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK.

Andreas Baumbach (A)

Centre for Cardiovascular Medicine and Devices (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., A.B., A.A., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
Barts Cardiovascular Clinical Trials Unit (D.A.J., T.G., A.B., A.A.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
Queen Mary University of London, UK. Barts Interventional Group (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., C.V.B., A.B., A.W., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK.

Charlotte Manisty (C)

Department of Cardiac Imaging (J.C.M., C.D., C.M., F.P.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
ORCID: 0000-0003-0245-7090

Andrew Wragg (A)

Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
Queen Mary University of London, UK. Barts Interventional Group (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., C.V.B., A.B., A.W., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
ORCID: 0000-0002-8934-5712

Amrita Ahluwalia (A)

Centre for Cardiovascular Medicine and Devices (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., A.B., A.A., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
Barts Cardiovascular Clinical Trials Unit (D.A.J., T.G., A.B., A.A.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
ORCID: 0000-0001-7626-6399

Francesca Pugliese (F)

Department of Cardiac Imaging (J.C.M., C.D., C.M., F.P.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
ORCID: 0000-0001-7497-6266

Anthony Mathur (A)

Centre for Cardiovascular Medicine and Devices (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., A.B., A.A., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
Faculty of Medicine & Dentistry, and NIHR Barts Biomedical Research Centre, Barts Heart Centre and William Harvey Research Institute (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., J.C.M., C.D., C.V.B., A.B., C.M., A.W., A.A., F.P., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
Queen Mary University of London, UK. Barts Interventional Group (D.A.J., A.-M.B., M.K., K.S.R., M.A., L.W., N.F., R.R., C.V.B., A.B., A.W., A.M.), Barts Heart Centre, Barts Health NHS Trust, London, UK.
ORCID: 0000-0001-7941-9653

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Computed Tomography Cardiac Angiography Before...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Sujet âgé de 80 ans ou plus › Computed Tomography Cardiac Angiography Before...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Computed Tomography Cardiac Angiography Before...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Computed Tomography Cardiac Angiography Before...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Imagerie diagnostique › Tomographie › Tomographie à rayons X › Tomodensitométrie › Angiographie par tomodensitométrie › Computed Tomography Cardiac Angiography Before...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Techniques de diagnostic cardiovasculaire › Tests de la fonction cardiaque › Coronarographie › Computed Tomography Cardiac Angiography Before...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Ischémie myocardique › Maladie coronarienne › Maladie des artères coronaires › Computed Tomography Cardiac Angiography Before...
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