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有创冠状动脉造影与计算机断层扫描血管造影在评估分叉处经皮冠状动脉介入治疗中支架内再狭窄的梅兰分类方面的比较。

Comparison of Invasive Coronary Angiography Versus Computed Tomography Angiography to Assess Mehran Classification of In-Stent Restenosis in Bifurcation Percutaneous Coronary Intervention.

作者信息

Naeem Hesham, Khan Umar, Mohsin Muhammad, Niazi Khurram, Malik Jahanzeb, Satti Danish Iltaf, Anwar Waqas

机构信息

Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan.

Department of Pulmonary Medicine, University Hospital Kerry, County Kerry, Ireland.

出版信息

Am J Cardiol. 2022 Jun 1;172:11-17. doi: 10.1016/j.amjcard.2022.02.014. Epub 2022 Mar 26.

Abstract

The Mehran classification is used to determine the presence of in-stent restenosis (ISR) and characterization of its subtypes in invasive coronary angiography (ICA). The utility of computed tomography angiography (CTA) for the assessment of Mehran classification is unknown. We aimed to compare the agreement and reproducibility of Mehran classification between ICA and CTA and evaluate the sensitivity and specificity of both imaging methods. Consecutive patients who had ISR on ICA preceded with CTA before intervention were enrolled in our study. Modified Mehran's classification was employed by CTA and ICA to classify ISR into 4 subtypes: focal (type I [A, B, C]), intra-stent (type II [A, B, C]), proliferative (type III [A, B, C]), and total occlusion (type IV). Agreement between ISR classification and main vessel lesion length, reference vessel diameter, and bifurcation angles were compared. A total of 405 patients with 431 bifurcation percutaneous coronary interventions with ISR were included in this investigation. The total agreement between CTA and ICA for assessment of Mehran class was poor (kappa = 0.168). Proliferative ISR (25% vs 10%, p = 0.012) and total occlusions (24% vs 5%, p <0.001) were reclassified more often between ICA and CTA, respectively. CTA assessment of lesion length was significantly longer than that of ICA measurements in all subtypes of ISR (32.15 ± 5.23 vs 27.41 ± 3.63, p = 0.004). Receiver operating characteristic curve expressed CTA to be more sensitive and specific than ICA in diagnosing ISR. In conclusion, Mehran classification was significantly affected by imaging modality, and CTA results were more reproducible than ICA. Therefore, CTA evaluation of ISR may facilitate treatment options and generate a sound plan before the procedure.

摘要

梅兰分类法用于在有创冠状动脉血管造影(ICA)中确定支架内再狭窄(ISR)的存在及其亚型特征。计算机断层扫描血管造影(CTA)用于评估梅兰分类法的效用尚不清楚。我们旨在比较ICA和CTA之间梅兰分类法的一致性和可重复性,并评估两种成像方法的敏感性和特异性。在干预前先行CTA检查且ICA显示有ISR的连续患者被纳入我们的研究。CTA和ICA均采用改良的梅兰分类法将ISR分为4种亚型:局灶性(I型[A、B、C])、支架内(II型[A、B、C])、增殖性(III型[A、B、C])和完全闭塞(IV型)。比较了ISR分类与主血管病变长度、参考血管直径和分叉角度之间的一致性。本研究共纳入405例患者,其431处分叉经皮冠状动脉介入治疗存在ISR。CTA和ICA对梅兰分类评估的总体一致性较差(kappa = 0.168)。增殖性ISR(25%对10%,p = 0.012)和完全闭塞(24%对5%,p <0.001)在ICA和CTA之间分别更常被重新分类。在所有ISR亚型中,CTA对病变长度的评估明显长于ICA测量值(32.15±5.23对27.41±3.63,p = 0.004)。受试者工作特征曲线表明,CTA在诊断ISR方面比ICA更敏感和特异。总之,梅兰分类法受成像方式的影响显著,且CTA结果比ICA更具可重复性。因此,CTA对ISR的评估可能有助于治疗方案的选择,并在手术前制定合理的计划。

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