Accuracy of multidetector computed tomography for detection of coronary artery stenosis in acute coronary syndrome compared with stable coronary disease: a CORE64 multicenter trial substudy.
Accuracy of multidetector computed tomography for detection of coronary artery stenosis in acute coronary syndrome compared with stable coronary disease: a CORE64 multicenter trial substudy.
复制标题
与稳定冠心病相比，多排计算机断层扫描检测急性冠脉综合征冠状动脉狭窄的准确性：CORE64 多中心试验亚组研究。
DOI：
10.1016/j.ijcard.2014.08.130
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发表时间：
2014
影响因子：
3.5
通讯作者：
Cox,Chris
中科院分区：
文献类型：
--
作者：
Sara,Leonardo;Rochitte,CarlosE;Lemos,PedroA;Niinuma,Hiroyuki;Dewey,Marc;Shapiro,EdwardP;Gottlieb,Ilan;Mansur,AntônioP;Nicolau,JoséC;Lardo,AlbertC;Azevedo,ClerioF;Kalil-Filho,Roberto;Vavere,AndreaL;Cohn,Silvia;Cox,Chris
多探测器计算机断层血管造影（MDCTA）是一种有前途的方法，用于急性胸痛患者的风险评估。然而，其在高风险患者中的诊断性能尚未在大型国际多中心试验中进行研究。因此，在本研究中，我们试图估计MDCTA的诊断准确性，以检测显着的冠状动脉狭窄患者急性冠状动脉综合征（ACS）。MethodsPatients包括在CORE 64研究被归类为疑似ACS或非ACS的临床数据的基础上。一个64排冠状动脉MDCTA进行侵入性冠状动脉造影（伊卡）和两个考试进行了评估，由盲法，独立的核心laborators.ResultsFrom 371例患者，94被归类为疑似ACS和277非ACS。基于患者的分析显示，ACS组和非ACS组检测≥ 50%冠状动脉狭窄的受试者工作特征曲线下面积（AUC）分别为0.95（95% CI：0.88-0.98）和0.92（95% CI：0.88-0.95）（P = 0.29）。MDCTA的敏感性、特异性、阳性预测值和阴性预测值均为0.90（0.80-0.96）、0.88（0.70-0.98）、0.95（0.87-0.99）和0.77在疑似ACS患者中为0.58-0.90，在非ACS患者中为0.87（0.81-0.92）、0.86（0.79-0.92）、0.91（0.85-0.95）和0.82（0.74-0.89）（所有比较P NS）。疑似ACS组和非ACS组的平均钙评分（CS）分别为282 ± 449和435 ± 668。CS检测显着的冠状动脉狭窄的准确性是只有中度和没有或最小的冠状动脉钙化不能排除存在显着的冠状动脉狭窄，特别是在ACS patient.ConclusionsThe诊断准确性MDCTA检测显着的冠状动脉狭窄是高的，可比的ACS和非ACS患者。
BackgroundMulti-detector computed tomography angiography (MDCTA) is a promising method for risk assessment of patients with acute chest pain. However, its diagnostic performance in higher-risk patients has not been investigated in a large international multicenter trial. Therefore, in the present study we sought to estimate the diagnostic accuracy of MDCTA to detect significant coronary stenosis in patients with acute coronary syndrome (ACS).MethodsPatients included in the CORE64 study were categorized as suspected-ACS or non-ACS based on clinical data. A 64-row coronary MDCTA was performed before invasive coronary angiography (ICA) and both exams were evaluated by blinded, independent core laboratories.ResultsFrom 371 patients included, 94 were categorized as suspected ACS and 277 as non-ACS. Patient-based analysis showed an area under the receiver-operating-characteristic curve (AUC) for detecting ≥ 50% coronary stenosis of 0.95 (95% CI: 0.88–0.98) in ACS and 0.92 (95% CI: 0.88–0.95) in non-ACS group (P = 0.29). The sensitivity, specificity, positive and negative predictive values of MDCTA were 0.90(0.80–0.96), 0.88(0.70–0.98), 0.95(0.87–0.99) and 0.77(0.58–0.90) in suspected ACS patients and 0.87(0.81–0.92), 0.86(0.79–0.92), 0.91(0.85–0.95) and 0.82(0.74–0.89) in non-ACS patients (P NS for all comparisons). The mean calcium scores (CS) were 282 ± 449 in suspected ACS and 435 ± 668 in non-ACS group. The accuracy of CS to detect significant coronary stenosis was only moderate and the absence or minimal coronary artery calcification could not exclude the presence of significant coronary stenosis, particularly in ACS patients.ConclusionsThe diagnostic accuracy of MDCTA to detect significant coronary stenosis is high and comparable for both ACS and non-ACS patients.