Prognostic Assessment of Coronary Artery Bypass Patients With 64-Slice Computed Tomography Angiography Anatomical Information Is Incremental to Clinical Risk Prediction

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:58

Article

Small, Gary R.¹  Yam, Yeung¹  Chen, Li¹  Ahmed, Osman¹  Al-Mallah, Mouaz²  Berman, Daniel S.³  Cheng, Victor Y.³  Chinnaiyan, Kavitha⁴  Raff, Gilbert⁴  Villines, Todd C.⁵  Achenbach, Stephan⁶  Budoff, Matthew J.⁷  Cademartiri, Filippo^9,19  Callister, Tracy Q.⁹  Chang, Hyuk-Jae¹⁰  Delago, Augustin¹¹  Dunning, Allison^12,13  Hadamitzky, Martin¹⁴  Hausleiter, Jorg¹⁴  Kaufmann, Philipp^13,15,16  Lin, Fay^13,16,17  Maffei, Erica^8,9  Min, James K.^13,16,17  Shaw, Leslee J.¹⁸  Chow, Benjamin J. W.¹ 

[1] Univ Ottawa, Inst Heart, Dept Med Cardiol, Ottawa, ON K1Y 4W7, Canada

[2] Wayne State Univ, Dept Med, Henry Ford Hosp, Detroit, MI 48202 USA

[3] Cedars Sinai Med Ctr, Dept Imaging, Los Angeles, CA 90048 USA

[4] William Beaumont Hosp, Dept Cardiol, Royal Oak, MI USA

[5] Walter Reed Med Ctr, Dept Med, Washington, DC USA

[6] Univ Erlangen Nurnberg, Dept Med, Erlangen, Germany

[7] Harbor UCLA Med Ctr, Dept Med, Los Angeles, CA USA

[8] Univ Parma, Dept Radiol, I-43100 Parma, Italy

[9] Tennessee Heart & Vasc Inst, Hendersonville, TN USA

[10] Severance Cardiovasc Hosp, Div Cardiol, Seoul, South Korea

[11] Capitol Cardiol Associates, Albany, NY USA

[12] Weill Cornell Med Coll, Dept Publ Hlth, New York, NY USA

[13] New York Presbyterian Hosp, New York, NY USA

[14] Tech Univ Munich, Div Cardiol, Munich, Germany

[15] Univ Zurich Hosp, CH-8091 Zurich, Switzerland

[16] Weill Cornell Med Coll, Dept Med, New York, NY USA

[17] Weill Cornell Med Coll, Dept Radiol, New York, NY USA

[18] Emory Univ, Sch Med, Dept Med, Atlanta, GA USA

[19] Erasmus MC, Dept Radiol, Rotterdam, Netherlands

关键词: all-cause mortality;    computed tomography;    coronary angiography;    coronary artery bypass surgery;    prognosis;   

DOI  :  10.1016/j.jacc.2011.08.047

来源: Elsevier

【 摘 要 】

Objectives We sought to determine the incremental prognostic value of 64 multi-slice coronary computed tomography angiography (CCTA) in coronary artery bypass graft (CABG) patients. Background Prognostication in CABG patients can be difficult. Anatomical assessment of native coronary artery disease and graft patency might provide useful information, but the utility of CCTA in the assessment of CABG patients is unknown. Methods Six hundred fifty-seven CABG patients with all-cause mortality follow-up were identified from a multicenter CCTA registry, of 10,628 patients from 5 CCTA centers. Clinical risk was profiled with modified logistic and additive EuroSCOREs (European Systems for Cardiac Operative Risk Evaluations). The CCTA defined coronary anatomy. Patients were classified by unprotected coronary territory (UCT) or a summary of native vessel disease and graft patency: the coronary artery protection score (CAPS). Results Forty-four deaths occurred during a mean follow-up of 20 months. Left ventricular ejection fraction, creatinine, age, severity of native vessel disease, UCT, CAPS, and EuroSCOREs were univariate predictors of mortality (p < 0.001). In multivariate analysis with additive EuroSCORE, UCT (p = 0.004) and CAPS were predictive of events (p < 0.001). In comparison with additive EuroSCORE, CAPS score was associated with a 27% net reclassification index. Conclusions Coronary computed tomography angiography provides incremental anatomical data to clinical risk assessment to help determine the prognosis of patients after CABG. The CAPS evaluation with CCTA might help identify those patients at highest risk. (J Am Coll Cardiol 2011;58:2389-95) (C) 2011 by the American College of Cardiology Foundation

【 授权许可】

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