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A combination of anatomical and functional evaluations improves the prediction of cardiac event in patients with coronary artery bypass.

ABSTRACT: To study the usefulness of combined risk stratification of coronary CT angiography (CTA) and myocardial perfusion imaging (MPI) in patients with previous coronary-artery-bypass grafting (CABG).A retrospective, observational, single centre study.204 patients (84.3% men, mean age 68.7±7.6) undergoing CTA and MPI.CTA defined unprotected coronary territories (UCT; 0, 1, 2 or 3) by evaluating the number of significant stenoses which were defined as the left main trunk ?50% diameter stenosis, other native vessel stenosis ?70% or graft stenosis ?70%. Using a cut-off value with receiver-operating characteristics analysis, all patients were divided into four groups: group A (UCT=0, summed stress score (SSS)<4), group B (UCT?1, SSS<4), group C (UCT=0, SSS?4) and group D (UCT?1, SSS?4).Cardiac events, as a composite end point including cardiac death, non-fatal myocardial infarction, unstable angina requiring revascularisation and heart-failure hospitalisation, were observed in 27 patients for a median follow-up of 27.5 months. The annual event rates were 1.1%, 2%, 5.7% and 12.9% of patients in groups A, B, C and D, respectively (log rank p value <0.0001). Adding UCT or SSS to a model with significant clinical factors including left ventricular ejection fraction, time since CABG and Euro SCORE II improved the prediction of events, while adding UCT and SSS to the model improved it greatly with increasing C-index, net reclassification improvement and integrated discrimination improvement.The combination of anatomical and functional evaluations non-invasively enhances the predictive accuracy of cardiac events in patients with CABG.

SUBMITTER: Kawai H

PROVIDER: S-EPMC3831107 | biostudies-other | 2013

REPOSITORIES: biostudies-other

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A combination of anatomical and functional evaluations improves the prediction of cardiac event in patients with coronary artery bypass.

Kawai Hideki H Sarai Masayoshi M Motoyama Sadako S Ito Hajime H Takada Kayoko K Harigaya Hiroto H Takahashi Hiroshi H Hashimoto Shuji S Takagi Yasushi Y Ando Motomi M Anno Hirofumi H Ishii Junichi J Murohara Toyoaki T Ozaki Yukio Y

BMJ open 20131111 11

<h4>Objective</h4>To study the usefulness of combined risk stratification of coronary CT angiography (CTA) and myocardial perfusion imaging (MPI) in patients with previous coronary-artery-bypass grafting (CABG).<h4>Design</h4>A retrospective, observational, single centre study.<h4>Setting and patients</h4>204 patients (84.3% men, mean age 68.7±7.6) undergoing CTA and MPI.<h4>Main outcome measures</h4>CTA defined unprotected coronary territories (UCT; 0, 1, 2 or 3) by evaluating the number of sig ...[more]

PMID: 24220113

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Project description:Background: Cardio-regenerative cell therapies offer additional biologic support to coronary artery bypass surgery (CABG) and are aimed at functionally repairing the myocardium that suffers from or is damaged by ischemia. This non-randomized open-label study assessed the safety and feasibility of epicardial transplantation of atrial appendage micrografts (AAMs) in patients undergoing CABG surgery. Methods: Twelve consecutive patients destined for CABG surgery were included in the study. Six patients received AAMs during their operation and six patients were CABG-operated without AAMs transplantation. Data from 30 elective CABG patients was collected for a center- and time-matched control group. The AAMs were processed during the operation from a biopsy collected from the right atrial appendage. They were delivered epicardially onto the infarct scar site identified in preoperative late gadolinium enhancement cardiac magnetic resonance imaging (CMRI). The primary outcome measures at the 6-month follow-up were (i) patient safety in terms of hemodynamic and cardiac function over time and (ii) feasibility of therapy administration in a clinical setting. Secondary outcome measures were left ventricular wall thickness, change in myocardial scar tissue volume, changes in left ventricular ejection fraction, plasma concentrations of N-terminal pro-B-type natriuretic peptide levels, NYHA class, number of days in hospital and changes in the quality of life. Results: Epicardial transplantation of AAMs was safe and feasible to be performed during CABG surgery. CMRI demonstrated an increase in viable cardiac tissue at the infarct site in patients receiving AAMs treatment. Conclusions and Relevance: Transplantation of AAMs shows good clinical applicability as performed during cardiac surgery, shows initial therapeutic effect on the myocardium and has the potential to serve as a delivery platform for cardiac gene therapies. Trial Registration:ClinicalTrials.gov, identifier: NCT02672163.

Dataset Information

A combination of anatomical and functional evaluations improves the prediction of cardiac event in patients with coronary artery bypass.

Publications

A combination of anatomical and functional evaluations improves the prediction of cardiac event in patients with coronary artery bypass.

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