CT Perfusion Versus Coronary CT Angiography in Patients With Suspected In-Stent Restenosis or CAD Progression
CT Perfusion Versus Coronary CT Angiography in Patients With Suspected In-Stent Restenosis or CAD Progression
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DOI：
10.1016/j.jcmg.2019.05.031
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发表时间：
2020-03-01
影响因子：
14
通讯作者：
Pepi, Mauro
中科院分区：
文献类型：
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作者：
Andreini, Daniele;Mushtaq, Saima;Pepi, Mauro
本研究的目的是评估单独的冠状动脉计算机断层扫描血管造影术（CTA）的诊断性能，单独的计算机断层扫描（CTP）评估腺苷负荷心肌灌注，和冠状动脉CTA + CTP，使用16 cm Z轴覆盖扫描仪与有创冠状动脉造影术（伊卡）和血流储备分数（FFR）作为临床标准。支架再狭窄检测仍然具有挑战性。最近，CTP在疑似冠状动脉疾病患者中显示出比冠状动脉CTA更高的诊断能力。然而，很少有数据可用于CTP性能的患者与以前的支架implantation.METHODS连续稳定的患者与以前的冠状动脉支架提到伊卡入组。所有患者均接受了负荷心肌CTP和静息CTP +冠状动脉CTA。当有临床指征时，在伊卡期间进行有创FFR。在基于支架、区域和患者的分析中评价了冠状动脉CTA、CTP和冠状动脉CTA + CTP的诊断率和诊断准确性。（132名男性;平均年龄65.1 ± 9.1岁），在所有分析中，CTP诊断率显著高于冠状动脉CTA（基于地区[96.7% vs. 91.1%; p < 0.0001]和基于患者[96% vs. 68%; p < 0.0001]）。当伊卡用作金标准时，在所有分析中，CTP诊断准确性显著高于冠状动脉CTA（基于区域[92.1% vs. 85.5%，p < 0.03]和基于患者[86.7% vs. 76.7%，p < 0.03]）。与伊卡相比，一致的冠状动脉CTA + CTP评估显示出最高的诊断准确性值（在基于区域的分析中为95.8%）。CTP的诊断准确率明显高于冠状动脉CTA（75% vs.30.5%; p < 0.001）。冠状动脉CTA + CTP的辐射暴露为4.15 +/- 1.5 mSv。结论在冠状动脉支架植入患者中，与伊卡和侵入性FFR作为金标准相比，CTP显著提高了单独冠状动脉CTA的诊断率和准确性。(C)2020年由美国心脏病学会基金会。
OBJECTIVES The goal of this study was to assess the diagnostic performance of coronary computed tomography angiography (CTA) alone, adenosine-stress myocardial perfusion assessed by computed tomography (CTP) alone, and coronary CTA + CTP by using a 16-cm Z-axis coverage scanner versus invasive coronary angiography (ICA) and fractional flow reserve (FFR) as the clinical standard.BACKGROUND Diagnostic performance of coronary CTA for in-stent restenosis detection is still challenging. Recently, CTP showed additional diagnostic power over coronary CTA in patients with suspected coronary artery disease. However, few data are available on CTP performance in patients with previous stent implantation.METHODS Consecutive stable patients with previous coronary stenting referred for ICA were enrolled. All patients underwent stress myocardial CTP and rest CTP + coronary CTA. Invasive FFR was performed during ICA when clinically indicated. The diagnostic rate and diagnostic accuracy of coronary CTA, CTP, and coronary CTA + CTP were evaluated in stent-, territory-, and patient-based analyses.RESULTS In the 150 enrolled patients (132 men; mean age 65.1 +/- 9.1 years), the CTP diagnostic rate was significantly higher than that of coronary CTA in all analyses (territory based [96.7% vs. 91.1%; p < 0.0001] and patient based [96% vs. 68%; p < 0.0001]). When ICA was used as gold standard, CTP diagnostic accuracy was significantly higher than that of coronary CTA in all analyses (territory based [92.1% vs. 85.5%, p < 0.03] and patient based [86.7% vs. 76.7%, p < 0.03]). The concordant coronary CTA + CTP assessment exhibited the highest diagnostic accuracy values versus ICA (95.8% in the territory-based analysis). The diagnostic accuracy of CTP was significantly higher than that of coronary CTA (75% vs. 30.5%; p < 0.001). The radiation exposure of coronary CTA + CTP was 4.15 +/- 1.5 mSv.CONCLUSIONS In patients with coronary stents, CTP significantly improved the diagnostic rate and accuracy of coronary CTA alone compared with both ICA and invasive FFR as gold standard. (C) 2020 by the American College of Cardiology Foundation.