{
  "abstract": "Background Around 20,000 patients undergo coronary artery bypass graft (CABG) operations in the United Kingdom each year. Despite advances in percutaneous coronary intervention (PCI), CABG remains the gold standard for the management of complex multi-vessel coronary disease. Approximately 80% of CABG patients have venous grafts (VG) and these are at high risk of failure (40-50% at 10 years), frequently requiring PCI to the VG (VG-PCI). These procedures are technically challenging, and there is some evidence that VG-PCI is associated with poorer long-term outcomes compared to native vessel PCI. Computerised tomography coronary angiography (CTCA) is highly sensitive and specific in identifying VG disease, and the BYPASS-CTCA trial has highlighted its potential when used before VG-PCI. However, there remains a lack of evidence for the use of CTCA after VG-PCI.Aims To evaluate whether CTCA to assess for early stent failure after VG-PCI can have an impact on long-term clinical outcomes.Methods We analysed prospectively collected data for patient’s undergoing VG-PCI at our institution between September 2016 and February 2024. Electronic records were reviewed to assess patient baseline characteristics and clinical outcomes. Patients were split into groups according to whether they received a CTCA to assess the VG-PCI result or not. Outcomes of interest were cardiovascular mortality, major adverse cardiovascular events (MACE) and target-vessel failure (TVF) which was a composite of target-vessel myocardial infarction or revascularisation and cardiovascular death where no other cause was found. Outcomes were assessed up to 48-months.Results A total of 389 patients were included in the study, with 106 patients having a planned CTCA after VG-PCI. The majority (345 (88.6%)) were male, and the mean age of the cohort was 72 years (standard deviation 9.8 years). The median time to time to CTCA was 11 months (interquartile range 3-27 months). Overall, 37 (34.9%) patients receiving a CTCA were referred for invasive coronary angiography and 29 (27.4%) were seen in clinic for medical optimisation based on CTCA findings. The baseline characteristics of the CTCA and no-CTCA groups were well matched. Patient’s receiving CTCA after VG-PCI were less likely to suffer cardiovascular mortality (multivariable-adjusted hazard ratio (HR) 0.28, 95% confidence interval (CI) 0.098-0.63, p=0.019) and MACE (multivariable-adjusted HR 0.30, 95% CI 0.18-0.46, p<0.001, figure 1). There was also evidence of a reduction in TVF for the CTCA group (HR 0.55, 95% CI 0.35-0.86, p=0.0092).Conclusion The use of CTCA after VG-PCI may help to identify patients with evidence of early stent failure and lead to post-procedural optimisation or treatment of native vessel disease. A reduction in clinical events may be associated with this treatment pathway. More studies in larger cohorts are required to confirm our findings and to gain insight into the optimal timing for CTCA.Abstract 39 Figure 1Kaplan-meier survival analysis comparing major adverse cardiovascular events in patients receiving CT coronary angiography following venous graft PCI (MACE = major adverse cardiovascular events, PCI = percutaneous coronary intervention)",
  "authors": [
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, United Kingdom"
      ],
      "name": "Tom Rayner"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, United Kingdom"
      ],
      "name": "Krishnaraj Rathod"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, United Kingdom"
      ],
      "name": "Anthony Mathur"
    },
    {
      "affiliations": [
        "St Bartholomew’s Hospital, London, United Kingdom"
      ],
      "name": "Dan Jones"
    }
  ],
  "title": "39 Improving outcomes for patients after venous graft percutaneous coronary intervention: is there a role for computerised tomography coronary angiography?",
  "uid": "18e6f958-01a2-513a-93b6-da014b9a7a74"
}