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European Heart Journal Advance Access originally published online on July 17, 2006
European Heart Journal 2007 28(15):1879-1885; doi:10.1093/eurheartj/ehl155
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Use of 64-slice CT in symptomatic patients after coronary bypass surgery: evaluation of grafts and coronary arteries

Patrizia Malagutti1,2, Koen Nieman1,2,*, Willem B. Meijboom1,2, Carlos A.G. van Mieghem1,2, Francesca Pugliese1,2, Filippo Cademartiri1,2, Nico R. Mollet1,2, Eric Boersma1, Peter P. de Jaegere1 and Pim J. de Feyter1,2

1 Department of Cardiology, Thorax Centre, Erasmus Medical Center, PO Box 2040, Rotterdam 3000CA, The Netherlands
2 Department of Radiology, Thorax Centre, Erasmus Medical Center, PO Box 2040, Rotterdam 3000CA, The Netherlands

Received 13 April 2006; revised 21 June 2006; accepted 29 June 2006; online publish-ahead-of-print 17 July 2006.

* Corresponding author. Tel: +31 10 463 5242; fax: +31 10 463 4320. E-mail address: koennieman{at}hotmail.com

Aims: Although previous generations of multislice computed tomography (CT) have demonstrated accurate detection of obstructive bypass graft disease, progression of coronary disease is a more frequent cause for ischaemic symptoms late after bypass graft surgery. We explored the diagnostic performance of 64-slice CT in symptomatic patients after bypass surgery, for the assessment of both grafts and native coronary arteries.

Methods and results: The 64-slice CT angiography (Siemens Sensation 64, Germany) was performed in 52 symptomatic patients, 10 ± 5 years after bypass surgery. Two independent, blinded observers assessed all grafts and coronary arteries for stenosis, using conventional quantitative angiography as a reference. A total of 109 grafts (182 graft segments), 123 distal coronary run-offs, and 116 non-bypassed coronary branches (288 segments) were analysed. Per-segment detection of graft disease yielded a sensitivity of 99% (71/72) and specificity of 96% (106/110). Sensitivity and specificity to detect run-off disease were 89% (8/9) and 93% (106/114), positive predictive value was 50% (8/16). In non-grafted coronary segments, CT detected significant stenosis with a sensitivity and specificity of 97% (62/64) and 86% (192/224). Overestimation occurred more frequently in calcified segments (P = 0.002).

Conclusion: The 64-slice CT allows angiographic evaluation of grafts and coronary arteries, although overestimation of coronary obstruction occurs, particularly in the presence of calcified disease.

Key Words: Computed tomography • Coronary angiography • Coronary artery disease • Coronary artery bypass surgery • Imaging


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