Potential of coronary computed tomography angiography in diagnosis of low‑risk acute coronary syndrome in patients with prior percutaneous coronary intervention and coronary artery bypass grafting

Aim. To evaluate the use of coronary computed tomography angiography (CCTA) in suspected non‑ST segment elevation (NSTE‑ACS) acute coronary syndrome in patients with prior percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).

Material and methods. The study included 155 patients with prior PCI or CABG (men, 57,4%; mean age, 65,1±9,2 years) with low‑risk NSTE‑ACS who underwent CCTA.

Results. Of the 155 patients who underwent CCTA, every fourth patient, namely 39 patients (25,2%), were referred for invasive coronary angiography (ICA). Among them, 26 patients had prior PCI, 8 patients — CABG, and 5 patients — both interventions. Patients indicated for ICA had higher coronary calcium score compared to patients who did not undergo ICA as follows: Me 268,0, Q1‑Q3: 78,5‑714,0 versus Me 163,5, Q1‑Q3: 18,0‑404,0, p=0,02. The positive and negative predictive value of CCTA in diagnosing stent damage was 66,7% and 92,2%, respectively, while in diagnosing bypass graft damage — 100% and 100%, respectively.

Conclusion. CCTA in patients with low‑risk NSTE‑ACS with prior PCI and/or CABG allows avoiding ICA in 75% of patients. CCTA is a reliable method for assessing the condition of coronary bypass grafts. At the same time, assessing stent patency using CCTA is a more complex task.

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