ICA in individuals with previous coronary artery bypass grafting (CABG) often requires longer procedural time and higher contrast and radiation exposure due to technical complexity. An AHA 2025 Sessions analysis evaluated whether guidance with CTCA can improve procedural performance in this population.

A systematic review of five studies, including two randomized controlled trials, compared CTCA-guided ICA with ICA alone in adults with prior CABG. Across all studies, 47.2% of participants underwent CTCA plus ICA. CTCA-guided procedures demonstrated significant reductions in procedural duration (−13.56 minutes; 95% CI −18.6 to −8.4; P<0.01), contrast volume (−30 mL; 95% CI −44.8 to −16.9; P<0.01), and radiation exposure (−185 mGy; 95% CI −311.3 to −60.2; P<0.01).

Secondary outcomes showed lower major adverse cardiovascular event (MACCE) rates with CTCA-guided ICA (RR 0.88; 95% CI 0.69–1.12; P<0.01), indicating potential benefit during follow-up.

These findings suggest that CTCA-guided ICA improves procedural efficiency and may help reduce cardiovascular risk in individuals with prior CABG.