Steinwender G, Szolar D, Preidler K, Tillich M, Zweiker R, Watzinger N
Klinische Abteilung für Kardiologie, Universitätsklinik für Innere Medizin, Medizinische Universtität Graz, Österreich.
Rofo. 2011 Dec;183(12):1145-50. doi: 10.1055/s-0031-1281732. Epub 2011 Sep 28.
Our aim was to evaluate the diagnostic accuracy of contrast-enhanced 64-MSCT coronary angiography (MSCT-CA) in patients with severe coronary calcification.
110 patients with an Agatston score > 400 were included in this retrospective analysis. Each patient underwent both conventional coronary angiography and MSCT-CA. No patient was excluded from the study because of coronary artery bypass grafting or coronary stenting. The results of MSCT-CA were compared with those of conventional coronary angiography and the diagnostic accuracy for detecting a hemodynamically significant stenosis was determined for coronary segments, vessels and patients.
The average Agatston score for the study population was 1368 ± 1105. At least one significant stenosis was detected in 97 patients (88%) during conventional coronary angiography defining the gold standard. The sensitivity, specificity, positive and negative predictive values of MSCT-CA for detecting a significant stenosis were 54%, 83%, 52% and 85% for coronary segments (n = 1384), 80%, 70%, 74% and 77% for coronary vessels (n = 440), and 100%, 31%, 92% and 100% for patients (n = 110), respectively. No significant correlation could be observed between the degree of coronary calcification and the number of misclassified coronary segments.
Artifacts caused by severe coronary calcification decrease the diagnostic accuracy of MSCT-CA. Performing MSCT-CA in patients with an Agatston score > 400 with the drawbacks of contrast media application and radiation exposure should be critically questioned and this decision should be made on an individual basis.
我们的目的是评估对比增强64层螺旋CT冠状动脉造影（MSCT-CA）对严重冠状动脉钙化患者的诊断准确性。
本回顾性分析纳入了110例阿加斯顿评分>400的患者。每位患者均接受了传统冠状动脉造影和MSCT-CA检查。没有患者因冠状动脉旁路移植术或冠状动脉支架置入术而被排除在研究之外。将MSCT-CA的结果与传统冠状动脉造影的结果进行比较，并确定冠状动脉节段、血管和患者检测血流动力学显著狭窄的诊断准确性。
研究人群的平均阿加斯顿评分为1368±1105。在定义为金标准的传统冠状动脉造影期间，97例患者（88%）检测到至少一处显著狭窄。MSCT-CA检测显著狭窄的冠状动脉节段（n=1384）的敏感性、特异性、阳性和阴性预测值分别为54%、83%、52%和85%，冠状动脉血管（n=440）的分别为80%、70%、74%和77%，患者（n=110）的分别为100%、31%、92%和100%。冠状动脉钙化程度与错误分类的冠状动脉节段数量之间未观察到显著相关性。
严重冠状动脉钙化引起的伪影降低了MSCT-CA的诊断准确性。对于阿加斯顿评分>400的患者进行MSCT-CA检查，鉴于造影剂应用和辐射暴露的缺点，应谨慎质疑，且该决定应个体化做出。
