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.

Computed tomography, Coronary angiography, Coronary artery bypass surgery, Coronary artery disease, Imaging,
European Heart Journal
Department of Cardiology

Malagutti, P, Nieman, K, Meijboom, W.B, van Mieghem, C.A.G, Pugliese, F, Cademartiri, F, … de Feyter, P.J. (2007). Use of 64-slice CT in symptomatic patients after coronary bypass surgery: Evaluation of grafts and coronary arteries. European Heart Journal, 28(15), 1879–1885. doi:10.1093/eurheartj/ehl155