Abstract 4364786: Computed Tomography Cardiac Angiography Guided vs Invasive Angiography Alone in Patients with Prior Coronary Artery Bypass Grafting: A Systematic Review and Meta-Analysis

Introduction: Patients with previous coronary artery bypass grafting (CABG) commonly need invasive coronary angiography (ICA). However, ICA in these patients is technically challenging leading to increased procedural time, contrast volume and radiation exposure. Recent clinical trials signified the importance of Computed tomography cardiac angiography (CTCA) in optimizing the ICA. Research Question: Does CTCA-guided ICA improve outcomes compared to invasive angiography alone in prior CABG patients? Methods/Approach: We systematically reviewed studies comparing CTCA-guided versus standard angiography in adults with prior CABG. Primary outcomes were procedural duration, contrast volume and radiation exposure (air kerma). Major adverse cardiovascular events (MACCE) were analyzed as a secondary outcome. Data were pooled using random-effects models and analysis was done using software R 4.3. Results: We included Five studies (two randomized controlled trials) in our analysis, among which 47.2% underwent CTCA+ICA. CTCA+ICA group demonstrated significant decrease in total procedural duration (−13.56 min; 95% CI: −18.6 to −8.4,P<0.01;Figure 1A), contrast volume (−30 ml; 95% CI: −44.8 to −16.9,P<0.01;Figure 1B) and radiation exposure (−185 mGy; 95% CI: −311.3 to −60.2,P<0.01;Figure 2) compared to ICA alone group. Additionally, the follow-up cardiovascular events were significantly lower in CTCA+ICA group compared to ICA alone group (RR: 0.88; 95% CI: 0.69–1.12;P<0.01;Figure 3). Conclusion: CTCA-guided ICA reduces procedure time, contrast use, and radiation in prior CABG patients. This approach may also lower follow-up cardiovascular events compared to ICA alone.