Karami Mehdi, Sajjadieh Amirreza, Moradi Ahmad, Taleb Akbar, Brumand Sareh
Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran.
Adv Biomed Res. 2017 Jul 28;6:92. doi: 10.4103/2277-9175.211796. eCollection 2017.
Diagnostic value of multi-slice computed tomography (MSCT) for detecting in-stent restenosis in comparison with conventional coronary angiography remained uncertain. The present study aimed to determine the value of MSCT for detecting in-stent restenosis.
This historical cohort study was included 226 patients with the history of percutaneous coronary intervention from 2000 to 2014 that referred to MSCT Unit at Alzahra Heart Center in Isfahan. The subjects were followed-up by telephone with regard to performing coronary angiography up to 3 months after MSCT and their status about cardiac events.
Among all participants, 63 stents (27.9%) underwent coronary angiography up to 3 months after MSCT that 2 stents in left circumflex artery (LCX) assessment, 2 in left anterior descending (LAD) assessments and none in right coronary artery (RCA) assessment were uninterpretable. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of MSCT was 92.9%, 66.6%. 92.9%, 66.6%, and 88.2%, respectively for detection of occlusion in LCX stents, 100%, 100%, 100%, 100%, and 100%, respectively for detection of occlusion in LAD stents, and 80.0%, 0.0%, 80.0%, 0.0%, and 66.7%, respectively for detection of occlusion in RCA stents. Overall, MSCT had sensitivity of 93.8%, specificity of 70.0%, PPV of 93.8%, NPV of 70.0%, and accuracy 89.7% for detection of coronary stent restenosis.
MSCT has high diagnostic value for detecting in-stent restenosis. Diagnostic accuracy of MSCT for detecting stent restenosis is considerably different between the coronary arteries with the highest diagnostic values for LAD and the lowest diagnostic values for RCA.
与传统冠状动脉造影相比，多层螺旋计算机断层扫描（MSCT）检测支架内再狭窄的诊断价值仍不确定。本研究旨在确定MSCT检测支架内再狭窄的价值。
这项历史性队列研究纳入了2000年至2014年期间在伊斯法罕的阿尔扎赫拉心脏中心MSCT科接受经皮冠状动脉介入治疗的226例患者。通过电话随访受试者，了解其在MSCT后3个月内进行冠状动脉造影的情况以及心脏事件状态。
在所有参与者中，63个支架（27.9%）在MSCT后3个月内接受了冠状动脉造影，其中左旋支动脉（LCX）评估中有2个支架、左前降支（LAD）评估中有2个支架、右冠状动脉（RCA）评估中无支架无法解读。MSCT检测LCX支架闭塞的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性分别为92.9%、66.6%、92.9%、66.6%和88.2%；检测LAD支架闭塞的敏感性、特异性、PPV、NPV和准确性分别为100%、100%、100%、100%和100%；检测RCA支架闭塞的敏感性、特异性、PPV、NPV和准确性分别为80.0%、0.0%、80.0%、0.0%和66.7%。总体而言，MSCT检测冠状动脉支架再狭窄的敏感性为93.8%，特异性为70.0%，PPV为93.8%，NPV为70.0%，准确性为89.7%。
MSCT检测支架内再狭窄具有较高的诊断价值。MSCT检测支架再狭窄的诊断准确性在LAD诊断价值最高和RCA诊断价值最低的冠状动脉之间存在显著差异。
