Coronary Artery Bypass Grafting Based on Computed Tomography-Derived Fractional Flow Reserve vs Angiography (CABG-COREA trial): Early Results.
Min-Seok Kim, Ah-Jin Ryu, Jung Won Kim et al.
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In 30 seconds
The CABG-COREA randomized trial compared early angiographic and clinical outcomes when coronary artery bypass grafting (CABG) targets were selected using computed tomography-derived fractional flow reserve (CT-FFR) or quantitative coronary angiography (QCA). Among 106 patients, the average number of revascularized arteries was similar between groups. CT-FFR guidance was associated with a higher proportion of perfectly patent grafts: 167 (85.2%) versus 133 (72.7%) with QCA (P = .007), alongside fewer competitive grafts. No operative deaths occurred, and morbidity did not differ between groups.
Key findings
- Mean revascularized arteries per patient were 3.7 ± 0.8 with CT-FFR and 3.5 ± 0.7 with QCA (P = .089).
- Perfectly patent grafts accounted for 167 (85.2%) in the CT-FFR group and 133 (72.7%) in the QCA group (P = .007).
- Competitive grafts were less frequent with CT-FFR: 10 (5.1%) bidirectionally and 19 (9.7%) unidirectionally, versus 23 (12.6%) and 27 (14.8%) with QCA.
- There was no operative mortality and no difference in morbidities between groups.
Why it matters
The findings suggest that physiological assessment with CT-FFR may help select CABG targets associated with better early graft-flow patterns, without increasing the average number of revascularized arteries. Competitive flow is relevant to graft function, but these early angiographic results do not establish whether the observed differences translate into improved longer-term clinical outcomes.
What to keep in mind
This is an early analysis of a randomized trial, with angiography performed at a median of 1 postoperative day; the abstract does not report the planned 1-year outcomes.