The BYPASS-CTCA Trial: Enhancing Cardiac Procedures with Pre-Operative CT Scans
In 2023, the BYPASS-CTCA Trial set out to redefine the pre-operative protocol for patients with a history of coronary artery bypass grafting (CABG). This open-label randomized controlled trial posed a crucial question: Can a noninvasive CT scan before invasive coronary angiography improve procedural outcomes in patients with prior CABG?
Objective of the BYPASS-CTCA Trial
The BYPASS-CTCA Trial’s objective was to evaluate the impact of preoperative computed tomography angiography (CTCA) on the procedural outcomes of invasive coronary angiography (ICA) in patients who had undergone CABG previously.
Trial Design and Patient Selection
A total of 688 patients were enrolled, meeting strict inclusion criteria: aged ≥18 years, with stable angina or non-ST elevation myocardial infarction (NSTEMI), and a history of CABG. Exclusion criteria were stringent, including ST elevation myocardial infarction (STEMI), hemodynamic or clinical instability, severe renal insufficiency, or any current life-threatening condition.
The Comparative Approach of the BYPASS-CTCA Trial
Participants were split into two groups: 344 received a noninvasive CT scan prior to ICA (Noninvasive CT Scan Group), while another 344 were assigned to the Control Group, proceeding without a CT scan.
Results of the BYPASS-CTCA Trial
Primary Outcomes
The Noninvasive CT Scan Group experienced significantly better outcomes:
- The average procedure duration was reduced to 18.6 minutes compared to 39.5 minutes in the Control Group.
- Contrast-induced nephropathy was reported in only 3.4% of cases in the CT Scan Group versus 27.9% in the Control Group.
- Patient satisfaction scores improved, averaging at 1.49 over 2.54 in the Control Group.
Secondary Outcome
There was a marked decrease in procedural complications such as myocardial infarction, stroke, or bleeding, reported at 2.3% in the CT Scan Group against 10.8% in the Control Group.
Conclusion and Implications for Cardiac Care
The BYPASS-CTCA Trial concluded that for patients with prior CABG, performing a CTCA before ICA leads to reductions in procedure time and contrast-induced nephropathy, and significantly boosts patient satisfaction. The findings advocate for the consideration of CTCA before ICA in this patient demographic, potentially leading to widespread changes in pre-operative practices for cardiac procedures.