冠脉CT血管造影对急性下壁心肌梗死罪犯血管的诊断价值

Diagnostic value of coronary CT angiography on culprit vessels of acute inferior myocardial infarction

目的探究冠状动脉CT血管造影(CTA)对急性下壁心肌梗死(AIMI)罪犯血管的诊断价值。方法选取成都市第三人民医院2019年1月到2021年12月收治的109例疑似AIMI患者,以数字减影血管造影(DSA)诊断结果作为“金标准”,对比分析CTA对AIMI罪犯血管的检出情况及不同罪犯血管的诊断价值。结果入组患者经临床诊断及冠状动脉造影术检查确诊为AIMI者99例,CTA诊断AIMI患者敏感度为93.94%(93/99),特异度为80.00%(8/10),准确率为92.66%(101/109),Kappa值为0.627;CTA检出罪犯血管的敏感度为88.06%(118/134),特异度为95.07%(212/223),准确率为92.44%(330/357),Kappa值为0.838;CTA定位右冠状动脉罪犯血管的准确率为90.29%(93/103),定位左冠状动脉回旋支罪犯血管的准确率为80.65%(25/31);经CTA成像显示:罪犯血管内非钙化与混合斑块发生率明显高于非罪犯血管(P<0.05);中重度狭窄血管内非钙化与混合斑块发生率明显高于轻度狭窄血管(P<0.05)。结论CTA可清晰显示冠状动脉血管狭窄程度及管腔内斑块特性,操作简易且无创伤,对AIMI罪犯血管有较高的诊断价值。

Objective To explore the diagnostic value of coronary CT angiography(CTA)on the culprit vessels of acute inferior myocardial infarction(AIMI).Methods A total of 109 patients with suspected AIMI admitted to the hospital from January 2019 to December 2021 were selected,and the diagnostic results of digital subtraction angiography(DSA)were used as the“gold standard”to compare the diagnostic value of CTA on the detection of AIMI culprit vessels and different culprit vessels.Results There were 99 patients diagnosed as AIMI by clinical diagnosis and CAG examination.The sensitivity,specificity,accuracy rate and Kappa value of CTA were 93.94%(93/99),80.00%(8/10),92.66%(101/109)and 0.627 in diagnosing patients with AIMI,and were 88.06%(118/134),95.07%(212/223),92.44%(330/357)and 0.838 in detecting culprit vessels.The accuracy rate of CTA was 90.29%(93/103)in locating RCA culprit vessels and was 80.65%(25/31)in locating LCX culprit vessels.The incidence rates of non-calcified and mixed plaques in culprit vessels were significantly higher than those in non-culprit vessels(P<0.05).The incidence rates of non-calcified and mixed plaques in moderate-to-severe stenotic vessels were significantly higher than those in mild vessels(P<0.05).Conclusion CTA can clearly display the degree of coronary stenosis and the characteristics of plaque in the lumen.It has simple operation and non-invasive feature,and has high diagnostic value on AIMI culprit vessels.