The role of computed tomographic angiography in predicting left anterior descending artery graftability when catheter angiography is inconclusive

Abstract

Clinical Research Presentation type: Oral Presentation Introduction: Graftability of the left anterior descending artery (LAD) has important prognostic value for coronary artery bypass graft (CABG) surgery. However, with a totally occluded LAD, catheter coronary angiography might be insufficient to determine its graftability. We evaluated coronary computed tomographic angiography (CTA) in the assessment of LAD graftability when the distal segment was not well visualized by catheter angiography Methodology: We enrolled 31 patients with equivocal eligibility for CABG due to total occlusion of the LAD with poor distal flow defined by catheter angiography. Patients with LAD diameters ⩾1.5 mm by CTA underwent CABG surgery, and the diameter was reassessed intraoperatively. Results: The mean age was 54 ± 14; seven patients (23%) had suitable LAD targets on CTA and underwent successful CABG (group A). Another 24 patients (77%) had non-graftable LADs (group B). T- test analysis of group (A) showed no significant difference between mean LAD diameter measured by CTA and during surgery (1.6 ± 0.3 mm vs. 1.5 ± 0.3 mm, P = .21). The preoperative ejection fraction (EF) was not significantly different between groups A and B (35 ± 8% vs. 35 ± 7%. P = .2). After 21 ± 7 months follow-up, EF was significantly higher in group A than in group B (41 ± 5.8% vs. 34 ± 8%. P = .01, respectively). Six patients had patent LAD grafts on CTA follow-up one year after the surgery. Conclusion: CTA may provide valuable information about LAD size and graftability when catheter angiography is inconclusive.