Document Detail


Evaluation of graft patency by computed tomographic angiography in symptom-free post-coronary artery bypass surgery patients.
MedLine Citation:
PMID:  18371591     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Accelerated atherosclerosis occurs in aortocoronary saphenous vein grafts, contributing to increased morbidity and mortality rates. We estimated the prevalence of asymptomatic graft failure in patients 5 years or more after coronary artery bypass grafting (CABG) using electron-beam computed tomographic angiography (EBA). METHODS AND RESULTS: EBA was performed in 45 symptom-free patients (mean age, 66 +/- 9 years; 87% male; mean time interval after CABG, 8 +/- 5 years). A total of 102 vein grafts and 37 internal mammary artery grafts were evaluated. Patients with graft stenosis or occlusion on EBA underwent myocardial perfusion scintigraphy and invasive angiography. Six grafts were unevaluable by EBA. Twenty patients had evidence of graft stenosis or occlusion on EBA. Of 20 asymptomatic patients with graft disease, 17 (85%) had abnormal myocardial perfusion, with moderate to severe reversible ischemia occurring in one third of subjects. Fourteen occluded and eleven stenosed vein grafts were correctly diagnosed by EBA. There were 2 false-positive EBA diagnoses of graft stenosis, resulting in a 100% positive predictive accuracy for detecting graft occlusion and 85% positive predictive accuracy for detecting graft stenosis. All occluded internal mammary artery grafts (n = 3) were accurately diagnosed. CONCLUSION: Computed tomographic coronary angiography permits reliable identification of bypass graft stenoses and occlusions in symptom-free patients more than 5 years after CABG. Future studies are needed to assess the prognostic benefit of early detection of graft disease and intervention in asymptomatic patients.
Authors:
Dhakshinamurthy Vijay Anand; Eric Lim; David Lipkin; Avijit Lahiri
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-03-06
Journal Detail:
Title:  Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology     Volume:  15     ISSN:  1532-6551     ISO Abbreviation:  J Nucl Cardiol     Publication Date:    2008 Mar-Apr
Date Detail:
Created Date:  2008-03-28     Completed Date:  2008-04-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9423534     Medline TA:  J Nucl Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  201-8     Citation Subset:  IM    
Affiliation:
Cardiac Imaging and Research Centre, Wellington Hospital, London, England. vdanand@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Aged
Coronary Angiography / methods*
Coronary Artery Bypass / adverse effects*
Coronary Stenosis / etiology*,  radiography*
Female
Graft Survival*
Humans
Male
Prognosis
Reproducibility of Results
Risk Assessment / methods*
Risk Factors
Sensitivity and Specificity
Tomography, X-Ray Computed / methods*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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