Coronary disease & ACSRandomised controlled trial
Computed tomography coronary angiography to facilitate clinical decision-making and selective invasive angiography in patients with prior bypass grafting presenting with acute coronary syndromes
- Randomised Controlled Trial
- anonymised case vignettes independently reviewed by 50 experienced interventional cardiologists
Authors' conclusion
Management decisions for post-CABG NSTE-ACS vary widely among experienced cardiologists. Incorporating CTCA into the diagnostic pathway substantially improves consensus, reduces unnecessary invasive angiography and enables targeted, lower-risk procedures. These findings support evaluation of a CTCA-guided strategy in a prospective randomised trial.
Study context
- Population
- Patients with prior coronary artery bypass grafting (CABG) presenting with non-ST-elevation acute coronary syndromes (NSTE-ACS) undergoing invasive coronary angiography (ICA), in the BYPASS-CTCA studypatients with NSTE-ACS whose vignettes and CT coronary angiography (CTCA) reports were reviewed by 50 interventional cardiologists, 5103 total case reviews
- Participants
- 150 patients
- Comparison
- Agreement on management strategy before and after CTCA
Primary result
As reported in the abstract
Agreement on management strategy (Fleiss’ κ)
Before CTCA
0.14
κ · 95% CI 0.11–0.17
After CTCA
0.53
κ · 95% CI 0.48–0.58
Further findings
Medical therapy selected
- Medical therapy selected: p<0.001
Among cases with invasive management selected post-CTCA
- Percutaneous coronary intervention (PCI) required, of cases with invasive management selected post-CTCA
- 85%
- Selective angiographic approach planned, of cases with invasive management selected post-CTCA
- 79%
Original publication
Computed tomography coronary angiography to facilitate clinical decision-making and selective invasive angiography in patients with prior bypass grafting presenting with acute coronary syndromes. Heart. Published 27 January 2026. doi:10.1136/heartjnl-2025-326961
Summarised from the published abstract; every number is checked against it