Lee Dae Hyun, Kambhampati S, Mohammed M, Goli R, Thiemann D, Lawson B, Resar J, Mohanty B
Division of Cardiovascular Sciences, Department of General Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, Florida.
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Int J Angiol. 2020 Dec;29(4):223-228. doi: 10.1055/s-0040-1716328. Epub 2020 Sep 20.
Coronary computed tomography angiography (CCTA) offers high-resolution anatomic characterization of the coronary vasculature but may be suboptimal for lesions dependent on real-time visualization of flow including chronic total occlusion (CTO). In CTOs, heavy calcification and distal vessel opacification from collateralization may confound luminal assessment. Several studies have examined the role of CCTA in characterizing known CTOs to guide percutaneous coronary intervention (PCI). However, the efficacy of CCTA in the de novo diagnosis of CTOs prior to coronary angiography (CAG) has not been demonstrated. A total of 233 consecutive patients who presented for CAG within a 3-month period of having CCTA were retrospectively reviewed. Those patients with prior diagnosis of CTO or prior bypass of the occluded vessels were excluded. Sensitivity and specificity analysis of CCTA in identifying CTOs using CAG as the gold standard was performed. The prevalence of CTO was 21.11% in the population that met criteria for analysis ( = 199). The sensitivity of CCTA in predicting CTO was 57.1%, while the specificity was 96.8%. The positive predictive value and negative predictive value of CCTA in detection of CTO were 82.8 and 89.4%, respectively. Our study shows that CCTA has excellent specificity but poor sensitivity in the detection of CTO thus limiting its clinical use in de novo diagnosis. Further studies to determine the effect of de novo CTO diagnosis on clinically important procedural factors, such as radiation exposure, contrast use, and need for repeat procedures, are warranted and may implicate a role for CCTA in this setting.
冠状动脉计算机断层扫描血管造影（CCTA）可提供冠状动脉血管系统的高分辨率解剖特征，但对于依赖血流实时可视化的病变，包括慢性完全闭塞（CTO），可能并不理想。在CTO病变中，严重钙化和侧支循环导致的远端血管显影可能会混淆管腔评估。多项研究探讨了CCTA在表征已知CTO以指导经皮冠状动脉介入治疗（PCI）中的作用。然而，CCTA在冠状动脉造影（CAG）之前对CTO进行初诊的有效性尚未得到证实。对在进行CCTA后3个月内接受CAG检查的233例连续患者进行了回顾性研究。排除那些先前诊断为CTO或先前已对闭塞血管进行搭桥手术的患者。以CAG作为金标准，对CCTA识别CTO的敏感性和特异性进行了分析。在符合分析标准的人群中（n = 199），CTO的患病率为21.11%。CCTA预测CTO的敏感性为57.1%，而特异性为96.8%。CCTA检测CTO的阳性预测值和阴性预测值分别为82.8%和89.4%。我们的研究表明，CCTA在检测CTO方面具有出色的特异性，但敏感性较差，因此限制了其在初诊中的临床应用。有必要进一步研究确定CTO初诊对临床重要操作因素的影响，如辐射暴露、造影剂使用和重复操作的必要性，这可能意味着CCTA在这种情况下的作用。
