Hinderks M J, Sliwicka O, Salah K, Sechopoulos I, Brink M, Cetinyurek-Yavuz A, Prokop W M, Nijveldt R, Habets J, Damman P
Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands.
Int J Cardiovasc Imaging. 2025 Jan;41(1):83-92. doi: 10.1007/s10554-024-03292-8. Epub 2024 Dec 6.
Coronary CT angiography (CCTA) and dynamic stress CT myocardial perfusion (CT-MPI) are established modalities in the analysis of patients with chronic coronary syndromes. Their role in patients with suspected non-ST elevation myocardial infarction (NSTEMI) is unknown. CCTA with CT-MPI might assist in the triage of NSTEMI patients to the Cath lab. We investigated the correlation of significant epicardial lesions by CT-MPI in addition to CCTA compared to invasive coronary angiography (ICA) with fractional flow reserve (FFR) in patients with NSTEMI. Twenty NSTEMI patients scheduled for ICA were enrolled in this study with planned ICA. CCTA and CT-MPI was performed pre-ICA. For each coronary artery, the presence or absence of significant lesions was interpreted by CCTA with CT-MPI, using an FFR of ≤ 0.8 or angiographic culprit (stenosis > 90%, suspected plaque rupture) as reference. The main outcome was the per-vessel correlation. Sixteen out of 20 patients had a culprit lesion that required immediate revascularization. CCTA with ≥ 50% stenosis demonstrated a per vessel sensitivity and specificity for the detection of significant stenosis of respectively 100% (95% CI: 86-100%) and 75% (95% CI: 58-88%). CCTA with CT-MPI showed a lower sensitivity 90% (95% CI: 70-99%) but higher specificity of 100% (95% CI: 90-100%). CCTA with CT-MPI exhibits a strong correlation for identifying significant CAD in patients with NSTEMI. Thereby, it might assist in the triage of ICA in NSTEMI patients.
冠状动脉CT血管造影（CCTA）和动态负荷CT心肌灌注成像（CT-MPI）是分析慢性冠状动脉综合征患者的既定方法。它们在疑似非ST段抬高型心肌梗死（NSTEMI）患者中的作用尚不清楚。CCTA联合CT-MPI可能有助于将NSTEMI患者分诊至导管室。我们研究了NSTEMI患者中，除CCTA外，CT-MPI所显示的显著心外膜病变与有血流储备分数（FFR）的有创冠状动脉造影（ICA）之间的相关性。本研究纳入了20例计划进行ICA的NSTEMI患者。在ICA前进行CCTA和CT-MPI检查。对于每支冠状动脉，使用FFR≤0.8或血管造影罪犯病变（狭窄>90%，疑似斑块破裂）作为参考，通过CCTA联合CT-MPI判断是否存在显著病变。主要观察指标是每支血管的相关性。20例患者中有16例有需要立即进行血运重建的罪犯病变。狭窄≥50%的CCTA检测显著狭窄的每支血管敏感性和特异性分别为100%（95%CI：86-100%）和75%（95%CI：58-88%）。CCTA联合CT-MPI的敏感性较低，为90%（95%CI：70-99%），但特异性较高，为100%（95%CI：90-100%）。CCTA联合CT-MPI在识别NSTEMI患者的显著冠状动脉疾病方面具有很强的相关性。因此，它可能有助于NSTEMI患者的ICA分诊。
