Kühl J Tobias, Hove Jens D, Kristensen Thomas S, Norsk Jakob B, Engstrøm Thomas, Køber Lars, Kelbæk Henning, Kofoed Klaus F
a Department of Cardiology , Heart Centre, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark.
b Department of Cardiology , Hvidovre Hospital, University of Copenhagen , Copenhagen , Denmark.
Scand Cardiovasc J. 2017 Feb;51(1):28-34. doi: 10.1080/14017431.2016.1207799. Epub 2016 Aug 9.
To test if cardiac computed tomography angiography (CCTA) can be used in the triage of patients at high risk of coronary artery disease.
The diagnostic value of 64-detector CCTA was evaluated in 400 patients presenting with non-ST segment elevation myocardial infarction using invasive coronary angiography (ICA) as the reference method. The relation between the severity of disease by CCTA and a combined endpoint of death, re-hospitalization due to new myocardial infarction, or symptom-driven coronary revascularization was assessed.
CCTA detects significant (>50%) coronary artery diameter stenosis with a sensitivity, specificity, and positive and negative predictive value of 99%, 81%, 96% and 95%, respectively. CCTA was used to triage patients into guideline defined treatment groups of "no or medical treatment", "referral to percutaneous coronary intervention" or to "coronary artery bypass graft surgery" and was compared to the index ICA. CCTA correctly triaged patients in 86% of cases. During a median follow-up of 50 months, the presence of an occluded artery by CCTA was associated with adverse outcome.
CCTA has high diagnostic and prognostic value in patients with high likelihood of coronary artery disease and could, in theory, be used to triage high risk patients. As many obstacles remain, including logistical and safety issues, our study does not support the use of CCTA as an additional diagnostic test before ICA in an all-comer NSTEMI population.
检验心脏计算机断层扫描血管造影（CCTA）是否可用于对冠状动脉疾病高危患者进行分诊。
采用有创冠状动脉造影（ICA）作为参考方法，对400例非ST段抬高型心肌梗死患者评估64层探测器CCTA的诊断价值。评估CCTA所显示的疾病严重程度与死亡、因新发心肌梗死再次住院或症状驱动的冠状动脉血运重建这一联合终点之间的关系。
CCTA检测冠状动脉直径狭窄程度>50%时，灵敏度、特异度、阳性预测值和阴性预测值分别为99%、81%、96%和95%。CCTA用于将患者分诊至指南定义的“无需治疗或药物治疗”、“转诊接受经皮冠状动脉介入治疗”或“冠状动脉旁路移植术”治疗组，并与最初的ICA结果进行比较。CCTA在86%的病例中对患者进行了正确分诊。在中位随访50个月期间，CCTA显示存在动脉闭塞与不良结局相关。
CCTA在冠状动脉疾病可能性高的患者中具有较高的诊断和预后价值，理论上可用于对高危患者进行分诊。由于仍存在许多障碍，包括后勤和安全问题，我们的研究不支持在所有非ST段抬高型心肌梗死患者中，在ICA之前将CCTA用作额外的诊断检查。
