BYPASS-CTCA
Research type
Research Study
Full title
The BYPASS-CTCA Study: A Randomised controlled trial assessing the value of Computed Tomography Cardiac Angiography (CTCA) in reducing procedure duration, limiting post-procedural kidney damage and improving patient satisfaction in patients who had previous bypass operation undergoing invasive coronary angiography (ICA).
IRAS ID
239032
Contact name
Dan Jones
Contact email
Sponsor organisation
Queen Mary University of London
Duration of Study in the UK
3 years, 6 months, 1 days
Research summary
Many people suffer from angina (chest pain, which comes on with exertion and is relieved by rest), caused by narrowing’s in the coronary arteries, visualised by a special X-ray-based examination called a coronary angiogram. Angina can be treated with an operation in which the narrowings are bypassed, otherwise known as a coronary artery bypass graft (CABG). The problem is that over time these bypasses can narrow and block, therefore these patients often redevelop chest pain and require further coronary angiograms. For patients with previous bypasses, coronary angiography procedures can lead to a number of complications.
Procedures may last longer, lead to higher doses of radiation and higher contrast (x-ray dye) volumes which can be associated with kidney damage. This is because the placements of the grafts vary and therefore it can take longer to find them, subjecting patients to greater risks and more discomfort.Computerised Tomography Coronary Angiography (CTCA) involves using a CT scan to identify coronary artery narrowings. It has considerably fewer risks than coronary angiography and is very accurate at identifying the location of and blockages in bypass grafts. However, although the ability of CTCA to detect the position and patency of bypass grafts is well known, it is unclear whether this scan leads to safer coronary angiography.
This research will assess 688 patients with previous bypasses who are due to undergo coronary angiography. The aim is to see if the CT scan before the procedure can make angiography safer, shorter and more comfortable for the patient. Patients who are suitable will be allocated to either receive CTCA as part of their assessment or receive standard assessment without this test. Patient satisfaction with the tests, dye/radiation amount, procedure duration, complications and importantly kidney damage will all be recorded and compared between the two groups.
Summary of results
BYPASS-CTCA recruited 688 patients with a previous history of coronary artery bypass graft (CABG) surgery who had been referred for invasive coronary angiography (ICA) and randomised them to either have ICA alone, or a computed tomography cardiac angiography (CTCA) scan prior. Improvements in all primary endpoints were seen; patients in the CTCA group had angiograms that were significantly shorter (19 vs 40 minutes), a lower risk of kidney injury (3% vs 28%) and patient satisfaction with the ICA was also higher. In addition procedural complications and risk of major cardiac events at one year (death, heart attack, further stenting procedures) were also lower in the CTCA group.
REC name
London - Westminster Research Ethics Committee
REC reference
18/LO/1583
Date of REC Opinion
19 Oct 2018
REC opinion
Further Information Favourable Opinion