Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, Canada K1Y 4W7.
Eur Heart J. 2012 Mar;33(6):776-82. doi: 10.1093/eurheartj/ehr346. Epub 2011 Sep 4.
Computed tomographic coronary angiography (CTA) appears to be a useful modality for the detection of obstructive coronary artery disease (CAD). Recent data suggest that CTA may reduce the frequency of normal invasive coronary angiograms. However, there remains concern that the implementation of CTA could increase referrals to invasive coronary angiography (ICA). To further support the clinical acceptance of CTA, it is important to compare CTA to another accepted modality such as single photon emission computed tomography (SPECT). We followed a cohort of 64-slice CTA patients and a matched cohort of Tc-99m SPECT patients to determine downstream referrals for ICA and revascularization.
Consecutive CTA patients (without history of revascularization or cardiac transplantation) were prospectively enrolled and compared with a Tc-99m SPECT cohort (matched for age, gender, and Morise score). Each CTA and SPECT was evaluated for obstructive CAD and patients were followed for downstream ICA and revascularization. Of the 1221 patients in each cohort, 129 (10.6%) CTA patients and 125 (10.2%) SPECT patients were referred to ICA. Of those referred to ICA, obstructive CAD was confirmed in 105 (81.4%) CTA patients and in 88 (70.4%) SPECT patients. Differences in false positive rates were significantly lower in the CTA than the SPECT cohort (9.7 and 25.8%, respectively, P = 0.009). Rates of revascularization were similar in the CTA and SPECT cohorts (6.2 vs. 5.9%, respectively).
Compared with SPECT, CTA had similar referrals for ICA and revascularization rates but lower false positive rates. Computed tomographic coronary angiography appears to be a viable non-invasive diagnostic modality and does not appear to negatively impact upon ICA resources.
计算机断层扫描冠状动脉造影（CTA）似乎是一种有用的方法，可用于检测阻塞性冠状动脉疾病（CAD）。最近的数据表明，CTA 可能会减少正常的有创冠状动脉造影的频率。然而，人们仍然担心 CTA 的实施会增加对有创冠状动脉造影（ICA）的转诊。为了进一步支持 CTA 的临床接受度，将 CTA 与另一种被接受的方法（如单光子发射计算机断层扫描（SPECT））进行比较非常重要。我们对 64 层 CTA 患者和 Tc-99m SPECT 患者的匹配队列进行了随访，以确定 ICA 和血运重建的下游转诊情况。
连续纳入 CTA 患者（无血运重建或心脏移植史），并与 Tc-99m SPECT 队列进行比较（年龄、性别和 Morise 评分匹配）。对每位 CTA 和 SPECT 患者进行阻塞性 CAD 评估，并对患者进行 ICA 和血运重建的随访。在每个队列的 1221 例患者中，有 129 例（10.6%）CTA 患者和 125 例（10.2%）SPECT 患者被转诊进行 ICA。在转诊进行 ICA 的患者中，105 例（81.4%）CTA 患者和 88 例（70.4%）SPECT 患者的阻塞性 CAD 得到了证实。CTA 组的假阳性率明显低于 SPECT 组（分别为 9.7%和 25.8%，P = 0.009）。CTA 组和 SPECT 组的血运重建率相似（分别为 6.2%和 5.9%）。
与 SPECT 相比，CTA 对 ICA 的转诊率和血运重建率相似，但假阳性率较低。计算机断层扫描冠状动脉造影似乎是一种可行的非侵入性诊断方法，并且似乎不会对 ICA 资源产生负面影响。
