Kim Choongki, Hong Sung-Jin, Shin Sanghoon, Ahn Chul-Min, Kim Jung-Sun, Kim Byeong-Keuk, Ko Young-Guk, Choi Byoung-Wook, Choi Donghoon, Jang Yangsoo, Hong Myeong-Ki
Department of Internal Medicine.
Department of Cardiology, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea.
Coron Artery Dis. 2019 Nov;30(7):511-519. doi: 10.1097/MCA.0000000000000750.
We purposed to evaluate the reliability of coronary computed tomography angiography (CCTA) in patients with a CCTA finding of high-grade stenosis.
Between May 2015 and March 2017, patients who underwent invasive coronary angiography (ICA) because of detection of high-grade stenosis by CCTA ( ≥ 70% stenosis of epicardial arteries or ≥ 50% of the left main coronary artery; Coronary Artery Disease Reporting and Data System grade 4 or 5) were selected for this study from our prospective registry cohort.
Among 646 eligible patients, only 263 (41%) patients were correctly diagnosed with significant coronary artery disease on ICA as same as CCTA findings. The per-vessel analysis revealed that 620 (68%) of 916 affected vessels had confirmed concordant significant stenosis between the CCTA and ICA results. The concordance rate was 49% among the segments with identified plaques in the per-segment analysis. Revascularization of the target vessel identified with severe stenosis by CCTA was performed in 228 (35%) patients. A logistic regression analysis revealed that smoking [odds ratio (OR): 1.59, 95% confidence interval (CI): 1.04-2.42, P = 0.03], taller height (OR: 1.02, 95% CI: 1.00-1.05, P = 0.016), and presence of typical symptoms of angina (OR: 1.86, 95% CI: 1.34-2.59, P < 0.001) were found to increase the probability of diagnostic concordance. A greater calcified segment involvement score (OR: 0.88, 95% CI: 0.82-0.94, P < 0.001) was associated with a lower diagnostic concordance.
The diagnostic discordance between CCTA and ICA was frequently observed in patients who were diagnosed with a CCTA finding of high-grade stenosis.
我们旨在评估冠状动脉计算机断层扫描血管造影（CCTA）对发现有高度狭窄的患者的可靠性。
在2015年5月至2017年3月期间，从我们的前瞻性登记队列中选取因CCTA检测到高度狭窄（心外膜动脉狭窄≥70%或左主干冠状动脉狭窄≥50%；冠状动脉疾病报告和数据系统分级为4级或5级）而接受有创冠状动脉造影（ICA）的患者进行本研究。
在646例符合条件的患者中，只有263例（41%）患者在ICA上被正确诊断为患有与CCTA结果相同的显著冠状动脉疾病。按血管分析显示，916条受累血管中的620条（68%）在CCTA和ICA结果之间确认存在一致的显著狭窄。在逐段分析中，有斑块的节段之间的一致性率为49%。228例（35%）患者对CCTA识别出的严重狭窄的靶血管进行了血运重建。逻辑回归分析显示，吸烟[比值比（OR）：1.59，95%置信区间（CI）：1.04 - 2.42，P = 0.03]、身高较高（OR：1.02，95% CI：1.00 - 1.05，P = 0.016）以及存在典型心绞痛症状（OR：1.86，95% CI：1.34 - 2.59，P < 0.001）被发现会增加诊断一致性概率。更大的钙化节段累及评分（OR：0.88，95% CI：0.82 - 0.94，P < 0.001）与较低的诊断一致性相关。
在被CCTA诊断为高度狭窄的患者中，经常观察到CCTA与ICA之间的诊断不一致。
