Meta-Analysis of Coronary Bypass Graft Patency Assessment with Invasive versus Computed Tomography Angiography.
Review
Overview
abstract
BACKGROUND: Computed tomography (CT) coronary angiography has emerged as a non-invasive alternative for evaluating graft patency after coronary artery bypass grafting (CABG), but there is ongoing debate regarding its diagnostic performance compared to invasive coronary angiography, particularly for arterial and composite grafts. METHODS: MEDLINE, Embase, and Cochrane databases were searched to identify studies comparing CT coronary angiography to invasive coronary angiography for detection of graft occlusion in post-CABG patients. Outcomes included sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy. Meta-regression explored key modifiers. Pooled estimates were calculated using random-effects models, with heterogeneity measured via I2. RESULTS: Fifty studies met inclusion criteria, including 3,449 patients (25% women). CT coronary angiography sensitivity for graft occlusion was 0.96 (I2 = 48%), specificity was 0.97 (I2 = 46%), positive predictive value was 0.94 (I2 = 62%), negative predictive value was 0.98 (I2 = 41%) and overall diagnostic accuracy was 0.97 (I2 = 58%). The pooled incidence rate of graft occlusion across 7,506 included grafts was 0.08 per graft-year (PGY) (95% CI: 0.06-0.10) using a random-effects model, and 0.07 PGY (95% CI: 0.07-0.08). At meta-regression, study year, sample size, β-blocker use, number of slices, and time since surgery, but not type and configuration of CABG grafts, were significantly associated with CT coronary angiography sensitivity. CONCLUSIONS: CT coronary angiography detects coronary artery bypass graft occlusion with a high degree of sensitivity and specificity independently of graft type and configuration and can be used for imaging of every type of CABG graft.
