Ranjadayalan K, Mills P G, Sprigings D C, Mourad K, Magee P, Timmis A D
Department of Cardiology, Newham General Hospital, London.
BMJ. 1990 Mar 24;300(6727):777-80. doi: 10.1136/bmj.300.6727.777.
To determine the feasibility, safety, and diagnostic accuracy of coronary arteriography in the radiology department of a district general hospital using conventional fluoroscopy and videotape recording.
Observational study of the feasibility and safety of coronary arteriography in a district general hospital and analysis of its diagnostic accuracy by prospective within patient comparison of the video recordings with cinearteriograms obtained in a catheter laboratory.
Radiology department of a district general hospital and the catheter laboratory of a cardiological referral centre.
50 Patients with acute myocardial infarction treated with streptokinase who underwent coronary arteriography in a district general hospital three (two to five) days after admission. 45 Of these patients had repeat coronary arteriography after four (three to seven) days in the catheter laboratory of a cardiological referral centre.
Incidence of complications associated with catheterisation and the sensitivity and specificity of video recordings in the district general hospital (judged by two experienced observers) for identifying the location and severity of coronary stenoses.
Coronary arteriograms recorded on videotape in the district general hospital were obtained in 47 cases and apart from one episode of ventricular fibrilation (treated successfully by cardioversion) there were no complications of the procedure. 45 Patients were transferred for investigation in the catheter laboratory, providing 45 paired coronary arteriograms recorded on videotape and cine film. The specificity of the video recordings for identifying the location and severity of coronary stenoses was over 90%. Sensitivity, however, was lower and for one observer fell below 40% for lesions in the circumflex artery. A cardiothoracic surgeon judged that only nine of the 47 video recordings were adequate for assessing revascularisation requirements.
Coronary arteriography in the radiology department of a district general hospital is safe and feasible. Nevertheless, the quality of image with conventional fluoroscopy and video film is inadequate and will need to be improved before coronary arteriography in this setting can be recommended.
确定在地区综合医院放射科使用传统荧光透视和录像进行冠状动脉造影的可行性、安全性及诊断准确性。
对地区综合医院冠状动脉造影的可行性和安全性进行观察性研究，并通过将录像与在导管实验室获得的动脉造影片进行患者内前瞻性比较，分析其诊断准确性。
地区综合医院放射科和心脏病转诊中心导管实验室。
50例接受链激酶治疗的急性心肌梗死患者，在入院后三（二至五）天于地区综合医院接受冠状动脉造影。其中45例患者在四（三至七）天后于心脏病转诊中心导管实验室接受重复冠状动脉造影。
与导管插入术相关的并发症发生率，以及地区综合医院录像（由两名经验丰富的观察者判断）在识别冠状动脉狭窄位置和严重程度方面的敏感性和特异性。
地区综合医院47例患者成功获得了录像记录的冠状动脉造影片，除1例室颤（通过心脏复律成功治疗）外，该操作无并发症。45例患者被转至导管实验室进行检查，获得了45对录像记录的冠状动脉造影片和电影胶片记录的动脉造影片。录像在识别冠状动脉狭窄位置和严重程度方面的特异性超过90%。然而，敏感性较低，一名观察者对回旋支病变的敏感性低于40%。一名心胸外科医生判断，47份录像记录中只有9份足以评估血运重建需求。
地区综合医院放射科进行冠状动脉造影是安全可行的。然而，传统荧光透视和录像胶片的图像质量不足，在推荐在此环境下进行冠状动脉造影之前需要改进。
