曾接受过搭桥手术的患者在进行侵入性冠状动脉造影前进行 CTCA:BYPASS-CTCA 试验 3 年后的患者相关结果、成像资源利用率和心脏事件。

IF 6.1 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Matthew Kelham, Anne-Marie Beirne, Krishnaraj S Rathod, Mervyn Andiapen, Lucinda Wynne, Annastazia E Learoyd, Nasim Forooghi, Rohini Ramaseshan, James C Moon, Ceri Davies, Christos V Bourantas, Andreas Baumbach, Charlotte Manisty, Andrew Wragg, Amrita Ahluwalia, Francesca Pugliese, Anthony Mathur, Daniel A Jones
{"title":"曾接受过搭桥手术的患者在进行侵入性冠状动脉造影前进行 CTCA:BYPASS-CTCA 试验 3 年后的患者相关结果、成像资源利用率和心脏事件。","authors":"Matthew Kelham, Anne-Marie Beirne, Krishnaraj S Rathod, Mervyn Andiapen, Lucinda Wynne, Annastazia E Learoyd, Nasim Forooghi, Rohini Ramaseshan, James C Moon, Ceri Davies, Christos V Bourantas, Andreas Baumbach, Charlotte Manisty, Andrew Wragg, Amrita Ahluwalia, Francesca Pugliese, Anthony Mathur, Daniel A Jones","doi":"10.1161/CIRCINTERVENTIONS.124.014142","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>In patients with previous coronary artery bypass grafting, computed tomography cardiac angiography (CTCA) before invasive coronary angiography (ICA) was demonstrated in the BYPASS-CTCA trial (Randomized Controlled Trial to Assess Whether Computed Tomography Cardiac Angiography Can Improve Invasive Coronary Angiography in Bypass Surgery Patients) to reduce procedure time and incidence of contrast-associated acute kidney injury, with greater levels of patient satisfaction. Patient-related outcomes, utilization of further diagnostic imaging resources, and longer-term incidence of major adverse cardiac events were key secondary end points not yet reported.</p><p><strong>Methods: </strong>Patients with prior coronary artery bypass grafting referred for ICA were randomized 1:1 to undergo CTCA before ICA or ICA alone and followed up for a median of 3 (2.2-3.4) years. Angina status was assessed using the Seattle Angina Questionnaire and overall quality of life using the EQ-5D-5L. The incidence of noninvasive imaging use and major adverse cardiac events were compared between the 2 groups.</p><p><strong>Results: </strong>In all, 688 patients were randomized, 344 to CTCA+ICA and 344 to ICA only. The mean age of participants was 69.8 years, with 45% undergoing ICA for acute coronary syndromes and the remainder stable angina. At 3 months follow-up, patients in the CTCA+ICA group were more likely to be angina-free (51.7% versus 43.2%; <i>P</i>=0.03) with greater quality of life (EQ-5D-5L index, 81.6 versus 74.4; <i>P</i>=0.001), although these improvements did not persist. At 3 years follow-up, imaging resource use (35.8% versus 45.1%; odds ratio, 0.68 [95% CI, 0.50-0.92]; <i>P</i>=0.013) and incidence of major adverse cardiac events were lower in the CTCA+ICA group (35.8% versus 43.5%; hazard ratio, 0.73 [95% CI, 0.58-0.93]; <i>P</i>=0.010).</p><p><strong>Conclusions: </strong>In patients with prior coronary artery bypass grafting undergoing ICA, CTCA before ICA leads to reductions in the use of imaging resources and the rate of major cardiac events out to 3 years, but with similar patient-related outcome measures. Together with the initial findings of BYPASS-CTCA, these data are supportive of routinely undertaking a CTCA before ICA in patients with prior coronary artery bypass grafting.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT03736018.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014142"},"PeriodicalIF":6.1000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"CTCA Prior to Invasive Coronary Angiography in Patients With Previous Bypass Surgery: Patient-Related Outcomes, Imaging Resource Utilization, and Cardiac Events at 3 Years From the BYPASS-CTCA Trial.\",\"authors\":\"Matthew Kelham, Anne-Marie Beirne, Krishnaraj S Rathod, Mervyn Andiapen, Lucinda Wynne, Annastazia E Learoyd, Nasim Forooghi, Rohini Ramaseshan, James C Moon, Ceri Davies, Christos V Bourantas, Andreas Baumbach, Charlotte Manisty, Andrew Wragg, Amrita Ahluwalia, Francesca Pugliese, Anthony Mathur, Daniel A Jones\",\"doi\":\"10.1161/CIRCINTERVENTIONS.124.014142\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>In patients with previous coronary artery bypass grafting, computed tomography cardiac angiography (CTCA) before invasive coronary angiography (ICA) was demonstrated in the BYPASS-CTCA trial (Randomized Controlled Trial to Assess Whether Computed Tomography Cardiac Angiography Can Improve Invasive Coronary Angiography in Bypass Surgery Patients) to reduce procedure time and incidence of contrast-associated acute kidney injury, with greater levels of patient satisfaction. Patient-related outcomes, utilization of further diagnostic imaging resources, and longer-term incidence of major adverse cardiac events were key secondary end points not yet reported.</p><p><strong>Methods: </strong>Patients with prior coronary artery bypass grafting referred for ICA were randomized 1:1 to undergo CTCA before ICA or ICA alone and followed up for a median of 3 (2.2-3.4) years. Angina status was assessed using the Seattle Angina Questionnaire and overall quality of life using the EQ-5D-5L. The incidence of noninvasive imaging use and major adverse cardiac events were compared between the 2 groups.</p><p><strong>Results: </strong>In all, 688 patients were randomized, 344 to CTCA+ICA and 344 to ICA only. The mean age of participants was 69.8 years, with 45% undergoing ICA for acute coronary syndromes and the remainder stable angina. At 3 months follow-up, patients in the CTCA+ICA group were more likely to be angina-free (51.7% versus 43.2%; <i>P</i>=0.03) with greater quality of life (EQ-5D-5L index, 81.6 versus 74.4; <i>P</i>=0.001), although these improvements did not persist. At 3 years follow-up, imaging resource use (35.8% versus 45.1%; odds ratio, 0.68 [95% CI, 0.50-0.92]; <i>P</i>=0.013) and incidence of major adverse cardiac events were lower in the CTCA+ICA group (35.8% versus 43.5%; hazard ratio, 0.73 [95% CI, 0.58-0.93]; <i>P</i>=0.010).</p><p><strong>Conclusions: </strong>In patients with prior coronary artery bypass grafting undergoing ICA, CTCA before ICA leads to reductions in the use of imaging resources and the rate of major cardiac events out to 3 years, but with similar patient-related outcome measures. Together with the initial findings of BYPASS-CTCA, these data are supportive of routinely undertaking a CTCA before ICA in patients with prior coronary artery bypass grafting.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT03736018.</p>\",\"PeriodicalId\":10330,\"journal\":{\"name\":\"Circulation: Cardiovascular Interventions\",\"volume\":\" \",\"pages\":\"e014142\"},\"PeriodicalIF\":6.1000,\"publicationDate\":\"2024-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Circulation: Cardiovascular Interventions\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1161/CIRCINTERVENTIONS.124.014142\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/11/25 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Circulation: Cardiovascular Interventions","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/CIRCINTERVENTIONS.124.014142","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/11/25 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0

摘要

背景:BYPASS-CTCA试验(评估计算机断层扫描心脏血管造影术能否改善搭桥手术患者的侵入性冠状动脉血管造影术的随机对照试验)显示,对于既往接受过冠状动脉搭桥术的患者,在进行侵入性冠状动脉血管造影术(ICA)前进行计算机断层扫描心脏血管造影术(CTCA)可缩短手术时间,降低造影剂相关急性肾损伤的发生率,并提高患者满意度。与患者相关的结果、进一步诊断成像资源的利用率以及主要不良心脏事件的长期发生率是尚未报告的关键次要终点:方法:对既往接受过冠状动脉旁路移植术、转诊接受 ICA 的患者按 1:1 随机分配,在 ICA 前接受 CTCA 或仅接受 ICA,并随访中位数 3(2.2-3.4)年。心绞痛状况使用西雅图心绞痛问卷进行评估,总体生活质量使用 EQ-5D-5L 进行评估。对两组患者的无创成像使用率和主要心脏不良事件发生率进行了比较:共有 688 名患者接受了随机治疗,其中 344 人接受了 CTCA+ICA 治疗,344 人仅接受了 ICA 治疗。参与者的平均年龄为 69.8 岁,其中 45% 因急性冠状动脉综合征而接受 ICA,其余为稳定型心绞痛。随访3个月时,CTCA+ICA组患者更有可能无心绞痛(51.7%对43.2%;P=0.03),生活质量更高(EQ-5D-5L指数,81.6对74.4;P=0.001),但这些改善并未持续。随访3年后,CTCA+ICA组的影像资源使用率(35.8%对45.1%;几率比0.68 [95% CI, 0.50-0.92];P=0.013)和重大心脏不良事件发生率(35.8%对43.5%;危险比0.73 [95% CI, 0.58-0.93];P=0.010)均低于CTCA+ICA组:对于既往接受过冠状动脉搭桥术的患者,在接受 ICA 之前进行 CTCA 可减少影像资源的使用,降低 3 年内重大心脏事件的发生率,但患者相关的结局指标相似。结合 BYPASS-CTCA 的初步研究结果,这些数据支持在对既往接受过冠状动脉旁路移植术的患者进行 ICA 前常规进行 CTCA:URL: https://www.clinicaltrials.gov; 唯一标识符:NCT03736018。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
CTCA Prior to Invasive Coronary Angiography in Patients With Previous Bypass Surgery: Patient-Related Outcomes, Imaging Resource Utilization, and Cardiac Events at 3 Years From the BYPASS-CTCA Trial.

Background: In patients with previous coronary artery bypass grafting, computed tomography cardiac angiography (CTCA) before invasive coronary angiography (ICA) was demonstrated in the BYPASS-CTCA trial (Randomized Controlled Trial to Assess Whether Computed Tomography Cardiac Angiography Can Improve Invasive Coronary Angiography in Bypass Surgery Patients) to reduce procedure time and incidence of contrast-associated acute kidney injury, with greater levels of patient satisfaction. Patient-related outcomes, utilization of further diagnostic imaging resources, and longer-term incidence of major adverse cardiac events were key secondary end points not yet reported.

Methods: Patients with prior coronary artery bypass grafting referred for ICA were randomized 1:1 to undergo CTCA before ICA or ICA alone and followed up for a median of 3 (2.2-3.4) years. Angina status was assessed using the Seattle Angina Questionnaire and overall quality of life using the EQ-5D-5L. The incidence of noninvasive imaging use and major adverse cardiac events were compared between the 2 groups.

Results: In all, 688 patients were randomized, 344 to CTCA+ICA and 344 to ICA only. The mean age of participants was 69.8 years, with 45% undergoing ICA for acute coronary syndromes and the remainder stable angina. At 3 months follow-up, patients in the CTCA+ICA group were more likely to be angina-free (51.7% versus 43.2%; P=0.03) with greater quality of life (EQ-5D-5L index, 81.6 versus 74.4; P=0.001), although these improvements did not persist. At 3 years follow-up, imaging resource use (35.8% versus 45.1%; odds ratio, 0.68 [95% CI, 0.50-0.92]; P=0.013) and incidence of major adverse cardiac events were lower in the CTCA+ICA group (35.8% versus 43.5%; hazard ratio, 0.73 [95% CI, 0.58-0.93]; P=0.010).

Conclusions: In patients with prior coronary artery bypass grafting undergoing ICA, CTCA before ICA leads to reductions in the use of imaging resources and the rate of major cardiac events out to 3 years, but with similar patient-related outcome measures. Together with the initial findings of BYPASS-CTCA, these data are supportive of routinely undertaking a CTCA before ICA in patients with prior coronary artery bypass grafting.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03736018.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Circulation: Cardiovascular Interventions
Circulation: Cardiovascular Interventions CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
10.30
自引率
1.80%
发文量
221
审稿时长
6-12 weeks
期刊介绍: Circulation: Cardiovascular Interventions, an American Heart Association journal, focuses on interventional techniques pertaining to coronary artery disease, structural heart disease, and vascular disease, with priority placed on original research and on randomized trials and large registry studies. In addition, pharmacological, diagnostic, and pathophysiological aspects of interventional cardiology are given special attention in this online-only journal.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信