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Ann Thorac Surg 2007;83:341-348
© 2007 The Society of Thoracic Surgeons

Reviews

Multi-Detector Computed Tomography in Coronary Artery Bypass Graft Assessment: A Meta-Analysis

Catherine M. Jones, MBBS, BSa, Thanos Athanasiou, MD, FECTSb,*, Nicola Dunne, MBBSc, Joanne Kirby, MbChBd, Omer Aziz, MRCS, BSb, Ahmed Haq, MBBSb, Christopher Rao, BSb, Vasilis Constantinides, MBBS, BSb, Sanjay Purkayastha, MRCS, BSb, Ara Darzi, FRCS, KBEb

a Department of Radiology, City Hospital, Birmingham, United Kingdom
b Department of Biosurgery and Surgical Technology & Department of Cardiothoracic Surgery, Imperial College, St Mary’s Hospital, London, United Kingdom
c Royal Berkshire and Battle NHS Trust, Reading, United Kingdom
d Birmingham Heartlands Hospital, Birmingham, United Kingdom

* Address correspondence to Dr Athanasiou, Imperial College, Department of Cardiothoracic Surgery, 111 Gowan Ave, Fulham, London, SW6 6RQ United Kingdom (Email: tathan5253{at}aol.com).

Multi-detector computed tomography (MDCT) has become an alternative to coronary angiography in diagnosis of graft occlusion and stenosis after coronary artery bypass. A literature search was performed for studies comparing angiography to 8-slice, 16-slice, and 64-slice MDCT in the assessment of coronary grafts. In assessing occlusion, 14 studies produced pooled sensitivity of 97.6%, specificity of 98.5%, diagnostic odds ratio of 934.2, area under the curve of 0.996, and Q* of 0.977. Ninety-six percent of all grafts were visualized for occlusion assessment. Beta blockers, symptomatic status, and postoperative period did not significantly affect diagnostic performance. Stenosis assessment produced sensitivity of 88.7% and specificity of 97.4%. Eighty-eight percent of patent grafts could be assessed for stenosis. The diagnostic accuracy of MDCT approaches angiography for diagnosing graft occlusion and stenosis in patients with venous and arterial coronary bypass grafts. Our findings show that cardiac surgeons will need to interpret MDCT images of both native and grafted vessels soon in preparation for primary or re-do coronary bypass grafting procedures.




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B. F. Buxton and P. Skillington
Invited Commentary
Ann. Thorac. Surg., April 1, 2008; 85(4): 1245 - 1246.
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