On the Inappropriateness of Noninvasive Multidetector Computed Tomography Coronary Angiography to Trigger Coronary Revascularization A Comparison With Invasive Angiography
On the Inappropriateness of Noninvasive Multidetector Computed Tomography Coronary Angiography to Trigger Coronary Revascularization A Comparison With Invasive Angiography
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DOI：
10.1016/j.jcin.2009.03.009
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发表时间：
2009-06-01
影响因子：
11.3
通讯作者：
Wijns, William
中科院分区：
文献类型：
--
作者：
Sarno, Giovanna;Decraemer, Isabel;Wijns, William
目的评价多排螺旋CT血管造影（MDCTA）作为冠状动脉病变诊断标准的合理性。MDCTA在管腔尺寸被侵犯之前很好地可视化斑块负荷和钙化。在81例接受CA和MDCTA的患者（116支血管）中获得。根据狭窄严重程度对节段进行视觉分级：G 0 =正常，G1 =非阻塞性（= 50%直径减小）。结果MDCTA和CA的节段严重程度评分之间的一致性良好（k = 0.74; 95%置信区间：0.56至0.92）。MDCTA基于血流储备分数检测功能显著狭窄的诊断性能较低（灵敏度79%;特异性64%;阳性似然比2.2;阴性似然比0.3）。在血流储备分数降低的情况下，认为血运重建是适当的（
Objectives Our purpose was to evaluate the appropriateness of multidetector computed tomography angiography (MDCTA) as an anatomical standard for decision making in patients with known or suspected coronary artery disease.Background Although correlative studies between MDCTA and coronary angiography (CA) show good agreement, MDCTA visualizes plaque burden and calcifications well before luminal dimensions are encroached.Methods Pressure-derived fractional flow reserve (FFR) was obtained in 81 patients (116 vessels) who underwent both CA and MDCTA. Segments were visually graded for stenosis severity as: G0 = normal, G1 = nonobstructive (= 50% diameter reduction).Results Concordance between segmental severity scores by MDCTA and CA was good (k = 0.74; 95% confidence interval: 0.56 to 0.92). Diagnostic performance of MDCTA for detection of functionally significant stenosis based on FFR was low (sensitivity 79%; specificity 64%; positive likelihood ratio 2.2; negative likelihood ratio 0.3). Revascularization was considered appropriate in the presence of reduced FFR (