Barbero Umberto, Iannaccone Mario, d'Ascenzo Fabrizio, Barbero Cristina, Mohamed Abdirashid, Annone Umberto, Benedetto Sara, Celentani Dario, Gagliardi Marco, Moretti Claudio, Gaita Fiorenzo
Cardiology Department, Città Della Salute e della Scienza Hospital, Turin, Italy.
Cardiology Department, Città Della Salute e della Scienza Hospital, Turin, Italy.
Int J Cardiol. 2016 Aug 1;216:52-7. doi: 10.1016/j.ijcard.2016.04.156. Epub 2016 Apr 22.
A non-invasive approach to define grafts patency and stenosis in the follow-up of coronary artery bypass graft (CABG) patients may be an interesting alternative to coronary angiography. 64-slice-coronary computed tomography is nowadays a diffused non-invasive method that permits an accurate evaluation of coronary stenosis, due to a high temporal and spatial resolution. However, its sensitivity and specificity in CABG evaluation has to be clearly defined, since published studies used different protocols and scanners. We collected all studies investigating patients with stable symptoms and previous CABG and reporting the comparison between diagnostic performances of invasive coronary angiography and 64-slice-coronary computed tomography. As a result, sensitivity and specificity of 64-slice-coronary computed tomography for CABG occlusion were 0.99 (95% CI 0.97-1.00) and 0.99 (95% CI: 0.99-1.00) with an area under the curve (AUC) of 0.99. 64-slice-coronary computed tomography sensitivity and specificity for the presence of any CABG stenosis >50% were 0.98 (95% CI: 0.97-0.99) and 0.98 (95% CI: 0.96-0.98), while AUC was 0.99. At meta-regression, neither the age nor the time from graft implantation had effect on sensitivity and specificity of 64-slice-coronary computed tomography detection of significant CABG stenosis or occlusion. In conclusion 64-slice-coronary computed tomography confirmed its high sensitivity and specificity in CABG stenosis or occlusion evaluation.
在冠状动脉旁路移植术（CABG）患者的随访中，一种用于确定移植血管通畅性和狭窄情况的非侵入性方法可能是冠状动脉造影的一个有趣替代方案。64层冠状动脉计算机断层扫描如今是一种广泛应用的非侵入性方法，由于其具有高时间和空间分辨率，能够对冠状动脉狭窄进行准确评估。然而，由于已发表的研究使用了不同的方案和扫描仪，其在CABG评估中的敏感性和特异性必须明确界定。我们收集了所有调查有稳定症状且曾接受CABG的患者，并报告了有创冠状动脉造影和64层冠状动脉计算机断层扫描诊断性能比较的研究。结果显示，64层冠状动脉计算机断层扫描对CABG闭塞的敏感性和特异性分别为0.99（95%CI 0.97 - 1.00）和0.99（95%CI：0.99 - 1.00），曲线下面积（AUC）为0.99。64层冠状动脉计算机断层扫描对任何CABG狭窄>50%的敏感性和特异性分别为0.98（95%CI：0.97 - 0.99）和0.98（95%CI：0.96 - 0.98），而AUC为0.99。在Meta回归分析中，年龄和移植血管植入后的时间对64层冠状动脉计算机断层扫描检测显著CABG狭窄或闭塞的敏感性和特异性均无影响。总之，64层冠状动脉计算机断层扫描在CABG狭窄或闭塞评估中证实了其高敏感性和特异性。
