From the Department of Radiology, Research Institute of Radiological Science (Y.J.S., Y.J.H., H.J.L., J.H., Y.J.K., S.R.H., T.H.K., B.W.C.), Department of Cardiovascular Surgery (K.J.Y.), and Division of Cardiology, Department of Internal Medicine (H.J.C.), Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea; and Department of Radiology, Chung-Ang University Medical Center, Seoul, Korea (J.S.S.).
Radiology. 2015 Aug;276(2):390-9. doi: 10.1148/radiol.15141216. Epub 2015 Mar 10.
To investigate the diagnostic performance of coronary computed tomographic (CT) angiography for selecting candidates for coronary artery bypass graft (CABG) surgery according to the 2011 American College of Cardiology Foundation (ACCF) and American Heart Association (AHA) guidelines for CABG surgery and determine the added value of SYNTAX (Synergy between PCI with TAXUS and Cardiac Surgery) scoring for selecting CABG surgery candidates.
Approval was obtained from the Institutional Review Board, and informed consent was waived for this retrospective study. A total of 399 patients (mean age, 63.8 years; 244 men and 155 women) who underwent both coronary CT angiography and invasive coronary angiography were included. Eligible criteria for CABG surgery were established on the basis of the 2011 ACCF/AHA guidelines.
from coronary CT angiography and invasive coronary angiography were retrospectively reviewed, and SYNTAX scores were determined. The diagnostic performance of coronary CT angiography for selecting CABG surgery candidates was calculated with invasive coronary angiography as the reference method. The diagnostic performance of coronary CT angiography alone, the CT-based SYNTAX score, and the combined coronary CT angiography with CT-based SYNTAX score were assessed by using a combination of invasive coronary angiography and invasive coronary angiography-based SYNTAX scores as a reference method. Statistical analyses were performed by using the generalized estimating equation, independent t test, Mann-Whitney U test, Wilcoxon signed rank test, Fisher exact test, and χ(2) statistics.
The overall sensitivity, specificity, positive predictive value (PPV), and negative predictive value of coronary CT angiography for selecting CABG surgery candidates were 96.5%, 96.5%, 88.3%, and 99.0%, respectively. When a combination of invasive coronary angiography with an invasive coronary angiography-based SYNTAX score was used as a standard reference, combined coronary CT angiography with a CT-based SYNTAX score had higher specificity and PPV (98.3% and 86.0%, respectively) than did coronary CT angiography alone (84.5% and 40.4%, respectively; P < .0001).
Coronary CT angiography had diagnostic accuracy comparable to that of invasive coronary angiography for selecting CABG surgery candidates, and combining a CT-based SYNTAX score with coronary CT angiography can be a highly specific method for selecting CABG surgery candidates.
根据 2011 年美国心脏病学会基金会（ACCF）和美国心脏协会（AHA）关于冠状动脉旁路移植术（CABG）的指南，研究冠状动脉计算机断层（CT）血管造影术对 CABG 手术候选者的诊断性能，并确定 SYNTAX（经皮冠状动脉介入治疗与 Taxus 和心脏手术的协同作用）评分对选择 CABG 手术候选者的附加价值。
本回顾性研究获得机构审查委员会的批准，并豁免了知情同意。共纳入 399 例（平均年龄 63.8 岁；244 例男性，155 例女性）患者，均行冠状动脉 CT 血管造影和有创性冠状动脉造影检查。根据 2011 年 ACCF/AHA 指南确定 CABG 手术的入选标准。
对冠状动脉 CT 血管造影和有创性冠状动脉造影的结果进行回顾性分析，并确定 SYNTAX 评分。以有创性冠状动脉造影为参考方法，计算冠状动脉 CT 血管造影术选择 CABG 手术候选者的诊断性能。单独使用冠状动脉 CT 血管造影术、基于 CT 的 SYNTAX 评分和联合冠状动脉 CT 血管造影术与基于 CT 的 SYNTAX 评分评估冠状动脉 CT 血管造影术的诊断性能。使用有创性冠状动脉造影和基于有创性冠状动脉造影的 SYNTAX 评分的组合作为参考方法，进行广义估计方程、独立 t 检验、Mann-Whitney U 检验、Wilcoxon 符号秩检验、Fisher 确切检验和 χ(2)统计分析。
冠状动脉 CT 血管造影术选择 CABG 手术候选者的总敏感度、特异度、阳性预测值（PPV）和阴性预测值分别为 96.5%、96.5%、88.3%和 99.0%。当使用有创性冠状动脉造影与基于有创性冠状动脉造影的 SYNTAX 评分的组合作为标准参考时，联合冠状动脉 CT 血管造影术与基于 CT 的 SYNTAX 评分的特异性和 PPV （分别为 98.3%和 86.0%）高于单独使用冠状动脉 CT 血管造影术（分别为 84.5%和 40.4%；P<0.0001）。
冠状动脉 CT 血管造影术对选择 CABG 手术候选者的诊断准确性与有创性冠状动脉造影术相当，并且联合 CT 基于 SYNTAX 评分与冠状动脉 CT 血管造影术可以是一种高度特异的选择 CABG 手术候选者的方法。
