Tuzcu E M, Berkalp B, De Franco A C, Ellis S G, Goormastic M, Whitlow P L, Franco I, Raymond R E, Nissen S E
The Cleveland Clinic Foundation, Department of Cardiology, Ohio 44195-5066, USA.
J Am Coll Cardiol. 1996 Mar 15;27(4):832-8. doi: 10.1016/0735-1097(95)00537-4.
We sought to determine whether careful examination of angiograms in conjunction with other clinical information could reliably detect, quantitate and localize target lesion calcification before a coronary intervention.
The presence, extent and location of calcium in coronary artery lesions are important determinants of outcome after coronary intervention. Intravascular ultrasound is proposed as a superior technique for identifying patients with coronary artery calcification. However, the precise role of this costly and invasive method has not yet been established.
Target lesion calcification was assessed in 183 patients (155 men; mean [+/-SD] age 58 +/- 10 years) by angiography and intravascular ultrasound before a planned percutaneous coronary intervention.
Ultrasound detected calcium in 138 patients (>90 degrees in 56, 91 degrees to 180 degrees in 52, 181 degrees to 270 degrees in 22 and > 270 degrees in 8), whereas angiography showed calcification in 63 (1+ in 32, 2+ in 27 and 3+ in 4). The two techniques agreed in 92 patients and disagreed in 91. Sensitivity and specificity of angiography were 40% and 82%, respectively. The arc of calcium by ultrasound was greater in patients with angiographically visible calcification (175 degrees +/- 85 degrees vs. 108 degrees +/- 71 degrees, p=0.0001). The depth of calcification by ultrasound was superficial in 61 patients (44%), deep in 68 (49%) and mixed in 8 (7%). The sensitivity of angiography in identifying superficial calcium was 35%. Of 120 patients without angiographically visible calcium at the target lesion site, 83 showed calcium by ultrasound. The only predictor of ultrasound calcium in these 120 patients was angiographic calcification elsewhere in the coronary tree (p=0.0001). The probability of any calcium and superficial >90 degrees calcium were 60% and 12%, respectively, in the 90 patients without angiographic calcifications anywhere in the coronary tree.
Despite poor sensitivity, angiography may help identify patients requiring intravascular ultrasound. When it is angiographically visible, the arc of calcium is likely to be large and superficial. Angiographic calcification at a remote site is a predictor of angiographically undetected target lesion calcium. Patients without angiographic calcification in the coronary tree may not need routine ultrasound examination, as the likelihood of >90 degrees superficial calcium is low.
我们试图确定结合其他临床信息仔细检查血管造影能否在冠状动脉介入治疗前可靠地检测、定量和定位靶病变钙化。
冠状动脉病变中钙的存在、范围和位置是冠状动脉介入治疗后预后的重要决定因素。血管内超声被认为是识别冠状动脉钙化患者的一种更优技术。然而，这种昂贵且有创方法的确切作用尚未确立。
在计划进行经皮冠状动脉介入治疗前，通过血管造影和血管内超声对183例患者（155例男性；平均[±标准差]年龄58±10岁）的靶病变钙化进行评估。
超声检测到138例患者有钙化（56例>90度，52例91度至180度，22例181度至270度，8例>270度），而血管造影显示63例有钙化（32例为1+，27例为2+，4例为3+）。两种技术在92例患者中结果一致，在91例患者中结果不一致。血管造影的敏感性和特异性分别为40%和82%。血管造影可见钙化的患者，超声检测到的钙弧更大（175度±85度对108度±71度，p=0.0001）。超声检测到的钙化深度，61例患者为浅表性（44%），68例为深部（49%），8例为混合性（7%）。血管造影识别浅表钙化的敏感性为35%。在靶病变部位血管造影未见钙化的120例患者中，83例经超声检测有钙化。在这120例患者中，超声检测到钙化的唯一预测因素是冠状动脉树其他部位的血管造影钙化（p=0.0001）。在冠状动脉树任何部位均无血管造影钙化的90例患者中，有任何钙化和浅表>90度钙化的概率分别为60%和12%。
尽管敏感性较差，但血管造影可能有助于识别需要进行血管内超声检查的患者。当血管造影可见时，钙弧可能较大且为浅表性。远处部位的血管造影钙化是血管造影未检测到的靶病变钙化的预测因素。冠状动脉树无血管造影钙化的患者可能不需要常规超声检查，因为浅表>90度钙化的可能性较低。
