Coronary bypass surgery guided by computed tomography in a low-risk population

Patrick W Serruys; Shigetaka Kageyama; Giulio Pompilio; Daniele Andreini; Gianluca Pontone; Saima Mushtaq; Mark La Meir; Johan De Mey; Kaoru Tanaka; Torsten Doenst; Ulf Teichgräber; Ulrich Schneider; John D Puskas; Jagat Narula; Himanshu Gupta; Vikram Agarwal; Jonathon Leipsic; Shinichiro Masuda; Nozomi Kotoku; Tsung-Ying Tsai; Scot Garg; Marie-Angele Morel; Yoshinobu Onuma

doi:10.1093/eurheartj/ehae199

Coronary bypass surgery guided by computed tomography in a low-risk population

Eur Heart J. 2024 Apr 7:ehae199. doi: 10.1093/eurheartj/ehae199. Online ahead of print.

Authors

Patrick W Serruys¹, Shigetaka Kageyama¹, Giulio Pompilio^{2

3}, Daniele Andreini^{4

5}, Gianluca Pontone², Saima Mushtaq², Mark La Meir⁶, Johan De Mey⁷, Kaoru Tanaka⁸, Torsten Doenst⁹, Ulf Teichgräber¹⁰, Ulrich Schneider⁹, John D Puskas¹¹, Jagat Narula¹², Himanshu Gupta¹³, Vikram Agarwal¹¹, Jonathon Leipsic¹⁴, Shinichiro Masuda¹, Nozomi Kotoku¹, Tsung-Ying Tsai¹, Scot Garg¹⁵, Marie-Angele Morel¹, Yoshinobu Onuma¹

Affiliations

¹ CORRIB Research Centre for Advanced Imaging and Core Lab, University of Galway, University Road, Galway H91 TK33, Ireland.
² Centro Cardiologico Monzino, IRCCS, Monzino, Italy.
³ Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milano, Italy.
⁴ Division of Cardiology and Cardiac Imaging, IRCCS Galeazzi Sant'Ambrogio, Milan, Italy.
⁵ Department of Biomedical and Clinical Sciences, University of Milan, Milano, Italy.
⁶ Department of Cardiac Surgery, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium.
⁷ Department of Radiology, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium.
⁸ Department of Radiology, University Hospital Brussels, Brussels, Belgium.
⁹ Department of Cardiothoracic Surgery, University Hospital Jena, Jena, Germany.
¹⁰ Department of Radiology, University Hospital Jena, Jena, Germany.
¹¹ Department of Cardiovascular Surgery, Mount Sinai Morningside, New York, NY, USA.
¹² University of Texas Health Science Center at Houston, Houston, TX, USA.
¹³ Department of Radiology, The Valley Hospital, Ridgewood, NJ, USA.
¹⁴ St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
¹⁵ Department of Cardiology, Royal Blackburn Hospital, Blackburn, UK.

PMID: 38583086
DOI: 10.1093/eurheartj/ehae199

Abstract

Background and aims: In patients with three-vessel disease and/or left main disease, selecting revascularization strategy based on coronary computed tomography angiography (CCTA) has a high level of virtual agreement with treatment decisions based on invasive coronary angiography (ICA).

Methods: In this study, coronary artery bypass grafting (CABG) procedures were planned based on CCTA without knowledge of ICA. The CABG strategy was recommended by a central core laboratory assessing the anatomy and functionality of the coronary circulation. The primary feasibility endpoint was the percentage of operations performed without access to the ICA. The primary safety endpoint was graft patency on 30-day follow-up CCTA. Secondary endpoints included topographical adequacy of grafting, major adverse cardiac and cerebrovascular (MACCE), and major bleeding events at 30 days. The study was considered positive if the lower boundary of confidence intervals (CI) for feasibility was ≥75% (NCT04142021).

Results: The study enrolled 114 patients with a mean (standard deviation) anatomical SYNTAX score and Society of Thoracic Surgery score of 43.6 (15.3) and 0.81 (0.63), respectively. Unblinding ICA was required in one case yielding a feasibility of 99.1% (95% CI 95.2%-100%). The concordance and agreement in revascularization planning between the ICA- and CCTA-Heart Teams was 82.9% with a moderate kappa of 0.58 (95% CI 0.50-0.66) and between the CCTA-Heart Team and actual treatment was 83.7% with a substantial kappa of 0.61 (95% CI 0.53-0.68). The 30-day follow-up CCTA in 102 patients (91.9%) showed an anastomosis patency rate of 92.6%, whilst MACCE was 7.2% and major bleeding 2.7%.

Conclusions: CABG guided by CCTA is feasible and has an acceptable safety profile in a selected population of complex coronary artery disease.

Keywords: Coronary artery bypass grafting; Coronary computed tomography; Feasibility; First-in-human; Proof-of-concept; Safety.

Associated data

ClinicalTrials.gov/NCT04142021

Abstract

Associated data

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