64-slice computed tomography coronary angiography in patients with high, intermediate, or low pretest probability of significant coronary artery disease
64-slice computed tomography coronary angiography in patients with high, intermediate, or low pretest probability of significant coronary artery disease
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DOI：
10.1016/j.jacc.2007.07.007
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发表时间：
2007-10-09
影响因子：
24
通讯作者：
de Feyter, Pim J.
中科院分区：
文献类型：
--
作者：
Meijboom, W. Bob;van Mieghem, Carlos A. G.;de Feyter, Pim J.
目的 我们评估了 64 层计算机断层扫描冠状动脉造影 (CTCA) 在检测或排除具有各种 CAD 预测试概率的患者中检测或排除冠状动脉疾病 (CAD) 的有用性。背景 CAD 存在的预测试概率可能会影响 CTCA 的诊断性能。方法 对 254 名有症状的患者进行了 64 层 CTCA（Sensation 64，西门子，福希海姆，德国）。心率 >= 65 次/分钟的患者在 CTCA 之前接受 β 受体阻滞剂治疗。根据胸部不适类型、年龄、性别和传统危险因素估计显着 CAD 的预测概率，并定义为高 (>= 71%)、中 (31% 至 70%) 和低 (定量冠状动脉造影 = 50% 冠状动脉狭窄，这是参考标准。没有冠状动脉节段被排除在分析之外。 结果 CAD 预测概率为高 (n = 105)、中 (n = 83) 和低(n = 66) 组中 3 个亚组的计算机断层扫描 (CT) 扫描的诊断性能不同，CT 扫描阴性后出现显着 CAD 的估计测试后概率分别为 17%、0% 和 0%，CT 扫描阳性后出现显着 CAD 的概率分别为 96%、88% 和 68%。血管造影对于具有显着 CAD 的估计预测概率为低或中等的有症状患者非常有用，并且 CT 扫描阴性可以可靠地排除显着 CAD 的存在。
Objectives We assessed the usefulness of 64-slice computed tomography coronary anglography (CTCA) to detect or rule out coronary artery disease (CAD) in patients with various estimated pretest probabilities of CAD.Background The pretest probability of the presence of CAD may impact the diagnostic performance of CTCA.Methods Sixty-four-slice CTCA (Sensation 64, Siemens, Forchheim, Germany) was performed in 254 symptomatic patients. Patients with heart rates >= 65 beats/min received beta-blockers before CTCA. The pretest probability for significant CAD was estimated by type of chest discomfort, age, gender, and traditional risk factors and defined as high (>= 71%), intermediate (31% to 70%), and low ( = 50% coronary stenosis on quantitative coronary angiography, which was the standard of reference. No coronary segments were excluded from analysis.Results The estimated pretest probability of CAD in the high (n = 105), intermediate (n = 83), and low (n = 66) groups was 87%, 53%, and 13%, respectively. The diagnostic performance of the computed tomography (CT) scan was different in the 3 subgroups. The estimated post-test probability of the presence of significant CAD after a negative CT scan was 17%, 0%, and 0% and after a positive CT scan was 96%, 88%, and 68%, respectively.Conclusions Computed tomography coronary angiography is useful in symptomatic patients with a low or intermediate estimated pretest probability of having significant CAD, and a negative CT scan reliably rules out the presence of significant CAD. Computed tomography coronary angiography does not provide additional relevant diagnostic information in symptomatic patients with a high estimated pretest probability of CAD.