Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, Charleston, SC 29425-2260, USA.
Radiology. 2012 Nov;265(2):385-92. doi: 10.1148/radiol.12112426. Epub 2012 Aug 8.
To assess the efficacy of coronary computed tomographic (CT) angiography for therapeutic decision making in patients with high likelihood of coronary artery disease (CAD)-specifically the ability of coronary CT angiography to help differentiate patients without and patients with a need for revascularization and determine the appropriate revascularization procedure.
The study protocol was approved by institutional review board, with written informed consent from all patients. The study was conducted in compliance with HIPAA. One hundred eighty-five consecutive symptomatic patients (121 men; mean age, 59.4 years±9.7) with a positive single photon emission computed tomography (SPECT) myocardial perfusion study underwent coronary CT angiography and conventional cardiac angiography (hereafter, cardiac catheterization). The management strategy (conservative treatment vs revascularization) and revascularization procedure (percutaneous coronary intervention [PCI] vs coronary artery bypass graft surgery [CABG]) were prospectively selected on the basis of a combination of coronary CT angiography and SPECT. In addition, the authors calculated the accuracy, sensitivity, specificity, and negative and positive predictive values of coronary CT angiography in the detection of obstructive CAD and the selection of a revascularization strategy. Cardiac catheterization was used as the standard of reference.
Of the 185 patients, 113 (61%) did not undergo revascularization and 42 (23%) were free of CAD. In 178 patients (96%), the same therapeutic strategy (conservative treatment vs revascularization) was chosen on the basis of coronary CT angiography and catheterization. All patients in need of revascularization were identified with coronary CT angiography. When revascularization was indicated, the same procedure (PCI vs CABG) was chosen in 66 of 72 patients (92%).
In patients with high likelihood of CAD, the performance of coronary CT angiography in the differentiation of patients without and patients with a need for revascularization and the selection of a revascularization strategy was similar to that of cardiac catheterization; accordingly, coronary CT angiography has the potential to limit the number of patients without obstructive CAD who undergo cardiac catheterization and to inform decision making regarding revascularization.
评估冠状动脉 CT 血管造影术（CTA）在高度疑似冠状动脉疾病（CAD）患者治疗决策中的作用——特别是 CTA 区分无血运重建需求和需要血运重建患者的能力，以及确定适当的血运重建方法。
本研究方案经机构审查委员会批准，所有患者均签署书面知情同意书。本研究符合 HIPAA 规定。185 例连续的有症状患者（121 例男性；平均年龄 59.4 岁±9.7 岁）行单光子发射计算机断层扫描（SPECT）心肌灌注显像阳性，并行冠状动脉 CTA 和常规心脏导管检查（下文简称心导管检查）。根据 CTA 和 SPECT 的综合结果，前瞻性选择（保守治疗或血运重建）和（经皮冠状动脉介入治疗[PCI]或冠状动脉旁路移植术[CABG]）治疗策略和血运重建方法。另外，作者计算了 CTA 在检测阻塞性 CAD 和选择血运重建策略中的准确性、敏感性、特异性和阴性及阳性预测值。以心导管检查作为参考标准。
185 例患者中，113 例（61%）未行血运重建，42 例（23%）无 CAD。178 例（96%）患者基于 CTA 和心导管检查选择了相同的治疗策略（保守治疗或血运重建）。所有需要血运重建的患者均通过 CTA 发现。当需要血运重建时，72 例患者中有 66 例（92%）选择了相同的方法（PCI 或 CABG）。
在高度疑似 CAD 的患者中，CTA 在区分无血运重建需求和有血运重建需求患者，以及选择血运重建策略方面的表现与心导管检查相似；因此，CTA 具有减少无阻塞性 CAD 患者行心导管检查数量，以及为血运重建决策提供信息的潜力。
