Ahn Sun Jun, Kang Doo Kyoung, Sun Joo Sung, Yoon Myeong-Ho
Departments of Radiology, School of Medicine, Ajou University, Suwon, South Korea.
J Comput Assist Tomogr. 2013 May-Jun;37(3):387-94. doi: 10.1097/RCT.0b013e318282d61c.
We assessed the accuracy of coronary computed tomography angiography (CTA) in patients with an Agatston calcium score (ACS) of greater than 400 by comparing it with invasive coronary angiography (ICA), and we evaluated the predictive value of CTA for obstructive coronary heart disease (CHD) compared with traditional clinical risk assessment.
A total of 253 patients who had an ACS of greater than 400 were enrolled in this study. The degree of coronary stenosis was visually and quantitatively estimated by postprocessing imaging using 15-segment coronary models. All patients underwent ICA after a mean (SD) of 34 (24) days, and the degree of coronary stenosis was compared with the results of CTA.
Computed tomography angiography accurately diagnosed significant stenosis in 204 (99.0%) of 206 patients and in 649 (83.5%) of 777 segments. When the patients were considered based on their ACS (group A, 400 < ACS ≤ 1000, vs group B, ACS > 1000), group B showed lower specificity (9.1% vs 41.7%) and poorer agreement (k = 0.149 vs 0.495) than for ICA. By segment-based analysis, the agreement between CTA and ICA was good (k = 0.729), and there was no significant difference between groups A (k = 0.728) and B (k = 0.727). Computed tomography angiography was the most powerful predictor (odds ratio = 52.645, P < 0.001), whereas the 10-year CHD risk and pretest probability were not significantly correlated with obstructive CHD.
Despite good overall diagnostic accuracy, coronary CTA in this group of patients was limited by low specificity. However, CTA was a better predictor of obstructive CHD compared with clinical predictors, and it avoided unnecessary ICA, even in patients with extensive coronary artery calcification.
通过将冠状动脉计算机断层扫描血管造影（CTA）与有创冠状动脉造影（ICA）进行比较，评估阿加斯顿钙评分（ACS）大于400的患者中冠状动脉CTA的准确性，并与传统临床风险评估相比，评估CTA对阻塞性冠心病（CHD）的预测价值。
本研究共纳入253例ACS大于400的患者。使用15段冠状动脉模型通过后处理成像对冠状动脉狭窄程度进行视觉和定量评估。所有患者在平均（标准差）34（24）天后接受ICA，并将冠状动脉狭窄程度与CTA结果进行比较。
计算机断层扫描血管造影准确诊断出206例患者中的204例（99.0%）以及777个节段中的649个节段（83.5%）存在显著狭窄。当根据患者的ACS进行分组时（A组，400＜ACS≤1000，与B组，ACS＞1000），B组的特异性低于ICA（9.1%对41.7%），一致性也较差（k=0.149对0.495）。通过基于节段的分析，CTA与ICA之间的一致性良好（k=0.729），A组（k=0.728）和B组（k=0.727）之间无显著差异。计算机断层扫描血管造影是最有力的预测指标（比值比=52.645，P＜0.001），而10年CHD风险和检查前概率与阻塞性CHD无显著相关性。
尽管总体诊断准确性良好，但该组患者的冠状动脉CTA受特异性低的限制。然而，与临床预测指标相比，CTA是阻塞性CHD更好的预测指标，并且即使在冠状动脉广泛钙化的患者中也避免了不必要的ICA。
