A clinical trial confirming the use of high-resolution scanning technology to identify heart disease has been hailed as safe, less invasive, more accurate and potentially a game-changer in cardiac treatment.

team of galway universityIn Ireland, CT scan images have been used as an alternative to traditional angiography (an invasive procedure that involves puncturing blood vessels, inserting cables and using dye) to accurately identify coronary artery disease and blockages.

independent person The team based at the same university CORRIB Core Labanalyzed images taken from patients at study hospitals in the United States and Europe.

This study european heart journal.

This approach was found to be 99.1% feasible and cardiac CT scans provided good diagnostic accuracy without the need for invasive diagnostic catheterization.

The trial was sponsored by the University of Galway and funded by Chicago-based GE Healthcare and California-based HeartFlow.

Trial chair Professor Patrick Seluis, a prestigious professor of interventional medicine and innovation at the University of Galway, said: “The results of this trial have the potential to simplify planning for patients undergoing heart bypass surgery.” .

“This trial and the central role played by the CORRIB Core Lab have placed the University of Galway at the forefront of cardiovascular diagnosis, planning and treatment of coronary artery disease.”

The study involved 114 patients with severe blockages in multiple blood vessels, restricting blood flow to the heart.

Serruys said the study suggests a potential “groundbreaking change in medicine.”

“Following the example of surgeons, interventional cardiologists may similarly consider avoiding traditional invasive cine angiography and instead relying solely on CT scans for surgical planning.” he said.

“This approach not only reduces the diagnostic burden on cath labs, but also paves the way for converting cath labs into dedicated ‘intervention suites’, ultimately enhancing patient workflow. ”

A randomized trial involving more than 2,500 patients will be conducted in 80 hospitals across Europe.

Dr Yosi Onuma, Professor of Interventional Cardiology and Medical Director of the CORRIB Research Center at the University of Galway, said the new approach had several advantages.

“Catheterization is invasive and uncomfortable for the patient,” he says. “Medical services also cost money. Although the risks associated with this procedure are minimal, they are not completely risk-free.”

Commenting on the research’s potential, he said: “It could be a game-changer that changes the traditional relationships between general practitioners, radiologists, cardiologists and cardiothoracic surgeons for the benefit of patients.” he added.

research content

Coronary artery bypass surgery with computed tomography in a low-risk population

Patrick Serruys, Shigetaka Kageyama, Yoshinobu Onuma et al.

Published in european heart journal April 7, 2024

abstract

Background and purpose
In patients with three-vessel disease and/or left main disease, the selection of a revascularization strategy based on coronary computed tomography angiography (CCTA) is at a substantially higher level than the treatment decision based on invasive coronary angiography (ICA). Match.

method
In this study, a coronary artery bypass grafting (CABG) procedure was planned based on CCTA without knowledge of ICA. The CABG strategy was recommended by a core laboratory evaluating the anatomy and function of the coronary circulation. The primary feasibility endpoint was the proportion of operations performed without accessing the ICA. The primary safety endpoint was graft patency at 30-day follow-up CCTA. Secondary endpoints included topographic adequacy of transplantation, major adverse cardiac and cerebrovascular events (MACCE), and major bleeding events at 30 days. Studies were considered positive if the lower bound of the feasibility confidence interval (CI) was 75% or higher (NCT04142021).

result
The study enrolled 114 patients with a mean (standard deviation) anatomical SYNTAX score of 43.6 (15.3) and a Society of Thoracic Surgeons score of 0.81 (0.63). One case required open-label ICA, and the feasibility was 99.1% (95% CI 95.2% to 100%). Concordance and agreement on revascularization plans between the ICA team and the CCTA cardiac team was 82.9% with a moderate kappa value of 0.58 (95% CI 0.50 to 0.66); 83.7%, with an effective kappa value of 0.61 (95% CI 0.53 to 0.68). Thirty-day follow-up CCTA in 102 patients (91.9%) showed anastomotic patency rate of 92.6%, MACCE of 7.2%, and major bleeding of 2.7%.

conclusion
CABG with CCTA is feasible and has an acceptable safety profile in selected populations with complex coronary artery disease.

European Heart Journal article – “CT-guided coronary artery bypass surgery in a low-risk population” (open access)

Independent article – New approach to diagnosing heart disease hailed as potential ‘game changer’ (Open Access)

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