Can the multi slice computertomography replace the conventional angiography for Follow-up evaluation of graft patency after total arterial myocardial revascularisation?

Introduction: Coronary angiography (CAG) is conventionally regarded as the gold standard in evaluating graft patency following coronary artery bypass grafting (CABG). Recently developed multi-slice CT (MSCT), having effective scan times up to 0.25s and multi-row detector array systems, enable rapid imaging of cardiac structures, including coronary arteries. The question remains if this technique may replace the conventional angiography.

Methods: From April to May 2006, as part of our evaluation of graft patency, 18 patients, who had received total arterial revascularization using composite left internal thoracic artery (LITA) and left radial artery (RA) as T-graft, were evaluated. Intraoperative angiography had been performed in these patients at the time of surgery to confirm 100% graft patency. Follow-up control (15–22 months) was performed with exercise ergometry (n=15), MSCT (n=13) and evaluation of quality of life (SF36) (n=18).

Result: Follow-up exercise ergometry showed no signs of angina or ECG-changes in all patients. Quality of life measurement revealed no impairment in all patients. MSCT showed occluded radial artery grafts in 2 patients. In 2 other patients interpretation was difficult due to resolution reasons. In all patients the LITA graft was patent.

Conclusion: Follow-up results showed excellent physical status and quality of life in all patients, including the 2 patients with occluded radial artery graft. MSCT can be used for postoperative non-invasive angiography with limitations in pts with small graft/ coronary diameters and arrhythmias. Despite the new CT technique, conventional angiography must still be considered the gold standard.