Catharina Hospital Eindhoven, Department of Cardiology, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands.
J Invasive Cardiol. 2022 May;34(5):E390-E396. doi: 10.25270/jic/21.00271. Epub 2022 Apr 22.
It is unknown whether computed tomographic coronary angiography (CTCA) can be used to perform ultraselective invasive coronary angiography (ICA) by only visualizing the abnormal coronary artery on CTCA and defer visualization of the normal contralateral coronary artery. This study assessed the accuracy of CTCA in patients with coronary artery disease (CAD) on CTCA limited to either the left (LCA) or right coronary artery (RCA) in predicting a contralateral coronary artery without abnormalities on CTCA determined to be normal by ICA.
This retrospective analysis included patients with CAD limited to the LCA or RCA on CTCA. Primary endpoint was the accuracy of CTCA to predict a contralateral coronary artery without abnormalities on CTCA to be normal by ICA. Secondary endpoints were potential reductions in procedure time and radiation exposure if an ultraselective ICA approach would be used compared to standard ICA.
In total, 202 patients were included. CTCA was correct in predicting a normal contralateral coronary artery in 201 of the 202 patients (99.5%). Deferring ICA of the normal contralateral coronary artery on CTCA resulted in a potential reduction in procedure time and dose area product of 4.22 ± 2.67 minutes (61 ± 16% reduction) and 1501 ± 1304 mGy•cm² (29 ± 13% reduction).
In this retrospective study, CTCA was extremely accurate in predicting a normal contralateral coronary artery in patients with LCA- or RCA-limited CAD on CTCA. A potential CTCA-guided ultraselective ICA approach was feasible and would have led to a considerable decrease in procedure time and radiation exposure.
目前尚不清楚是否可以通过仅在 CTCA 上观察到异常的冠状动脉，并延迟对正常对侧冠状动脉的显影，来利用计算机断层扫描冠状动脉造影（CTCA）进行超选择性冠状动脉造影（ICA）。本研究评估了 CTCA 在 CTCA 仅局限于左冠状动脉（LCA）或右冠状动脉（RCA）的冠心病（CAD）患者中的准确性，以预测 CTCA 上未见异常的对侧冠状动脉，该对侧冠状动脉通过 ICA 被确定为正常。
本回顾性分析纳入了 CTCA 上局限于 LCA 或 RCA 的 CAD 患者。主要终点是 CTCA 预测 CTCA 未见异常的对侧冠状动脉通过 ICA 被确定为正常的准确性。次要终点是如果采用超选择性 ICA 方法，与标准 ICA 相比，手术时间和辐射暴露是否有潜在减少。
共纳入 202 例患者。在 202 例患者中的 201 例（99.5%）中，CTCA 正确预测了正常的对侧冠状动脉。延迟对 CTCA 上正常对侧冠状动脉进行 ICA 检查可使手术时间和剂量面积乘积分别减少 4.22±2.67 分钟（减少 61%±16%）和 1501±1304 mGy•cm²（减少 29%±13%）。
在这项回顾性研究中，CTCA 在预测 CTCA 上 LCA 或 RCA 局限性 CAD 患者正常对侧冠状动脉方面具有极高的准确性。潜在的 CTCA 引导的超选择性 ICA 方法是可行的，并且会大大减少手术时间和辐射暴露。
