Barth Sebastian, Marwan Mohamed, Hausleiter Jörg, Moshage Werner, Korosoglou Grigorios, Leber Alexander, Schmermund Axel, Gohlke Helmut, Bruder Oliver, Dill Thorsten, Schröder Stephen, Kerber Sebastian, Hamm Karsten, Gietzen Frank, Schneider Steffen, Senges Jochen, Achenbach Stephan
Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Salzburger Leite 1, 97616, Bad Neustadt/Saale, Germany.
Department of Cardiology, Friedrich-Alexander-Universität, Erlangen-Nürnberg, Erlangen, Germany.
Int J Cardiovasc Imaging. 2019 Apr;35(4):741-748. doi: 10.1007/s10554-018-1504-0. Epub 2018 Nov 19.
To evaluate diagnostic impact of clinical use of coronary computed tomography angiography (CCTA) in patients with suspected stable coronary artery disease (CAD) and its consequences in daily practice for patient management, depending on stress test results in daily practice. Between 2009 and 2014 of a total population of 1352 patients of the German Cardiac Computed Tomography (CT) Registry who had previously undergone stress tests, CCTA visualizations were carried out on the coronary arteries with suspected stable CAD. Patients were divided into three groups according to stress test results: Group 1 with inconclusive (n = 178, 13.2%), Group 2 with ischemia in stress test (n = 372, 27.5%) and Group 3 without ischemia in stress test (n = 802, 59.3%). The test of preference was the stress electrocardiogram (ECG), which was performed more frequently in patients without ischemia in stress test as compared to those with ischemia (96.3% vs. 93.0%, p = 0.015). The incidence of detected obstructive CAD was lower in patients with suggested ischemia in stress test as compared to patients with inconclusive results (14.1% vs. 21.1%, p = 0.037). There was no difference in the incidence of an obstructive CAD in patients with and without ischemia in stress test (14.1% vs. 15.8%, p = 0.440). CCTA is a reliable, non-invasive option for ruling-out obstructive CAD irrespective of the stress test result.
为评估冠状动脉计算机断层扫描血管造影（CCTA）在疑似稳定型冠状动脉疾病（CAD）患者临床应用中的诊断影响及其在日常实践中对患者管理的影响，这取决于日常实践中的负荷试验结果。在2009年至2014年期间，德国心脏计算机断层扫描（CT）登记处的1352名患者中，有1352名患者之前接受过负荷试验，对疑似稳定型CAD的冠状动脉进行了CCTA可视化检查。根据负荷试验结果将患者分为三组：第1组为结果不确定（n = 178，13.2%），第2组为负荷试验中有缺血（n = 372，27.5%），第3组为负荷试验中无缺血（n = 802，59.3%）。首选的检查是负荷心电图（ECG），与有缺血的患者相比，在负荷试验中无缺血的患者中进行得更频繁（96.3%对93.0%，p = 0.015）。与结果不确定的患者相比，负荷试验提示有缺血的患者中检测到的阻塞性CAD发生率较低（14.1%对21.1%，p = 0.037）。负荷试验中有缺血和无缺血的患者中阻塞性CAD的发生率没有差异（14.1%对15.8%，p = 0.440）。无论负荷试验结果如何，CCTA都是排除阻塞性CAD的可靠、非侵入性选择。
