双源CT冠状动脉造影评估支架置入后的临床应用

Clinical application of dual-source computed tomography coronary angiography after stent implantation

目的探讨双源CT(DSCT)冠状动脉造影评估支架置入后再狭窄的能力。方法回顾分析行冠状动脉支架术后的56例患者资料,所有患者均行冠状动脉造影术(CAG)检查及DSCT冠状动脉血管成像检查,以CAG结果为标准,分析支架段冠状动脉平均内径狭窄情况。结果 56例患者74个支架,CAG显示发生再狭窄23个,DSCT显示发生再狭窄21个(P>0.05)。DSCT检测再狭窄的敏感性、特异性、阳性预测值、阴性预测值、准确率分别为91%、90%、81%、96%、91%。在直径≥3.0 mm的48个支架中,CAG检测出12个,DSCT检测出11个,DSCT检测再狭窄的敏感性93%、特异性91%、阳性预测值82%、阴性预测值97%、准确性92%。在直径<3.0 mm的26个支架中,CAG检测出8个,DSCT检测出7个,DSCT检测再狭窄的敏感性88%、特异性89%、阳性预测值78%、阴性预测值94%、准确性88%。结论 DSCT作为一种无创检测手段,在评估支架置入后再狭窄具有较高的敏感性、特异性、准确性,在评估大直径支架通畅情况可部分取代CAG。

Objective To evaluate the ability of the dual-source Computed Tomography(DSCT)coronary angio-graphy(CAG)to re-stenosis after stent implantation.Methods Retrospective analysis of 56 patients after coronary stenting,all patients were treated CAG examination And DSCT coronary angiography,based on CAG results,analysis of coronary mean diameter stenosis in stent segment.Results Fifty-six patients with 74 stents,CAG showed 23 restenosis,DSCT showed 21 restenosis,(P >0.05).The sensitivity,specificity,positive predictive value,negative predictive value,accuracy of DSCT in detecting restenosis were 91%,90%,81%,96%,91%.In 48 stents with diameter≥3.0 mm,CAG detected 12,DSCT detected 11,DSCT detection of restenosis sensitivity was 93%,specificity was 91%,positive predictive value was 82%,negative predictive value was 97%,accuracy was 92%.In 26 scaffolds with diameter<3.0 mm,CAG detected 8,DSCT detected 7,DSCT detection of restenosis sensitivity was 88%,specificity was 89%,positive predictive value was 78%,negative predictive value was 94%,accuracy was 88%.Conclusion DSCT as a noninvasive test,it has higher sensitivity,specificity and accuracy in assessing restenosis after stent implantation,it can partial replacement of CAG in assessing large diameter stent patency.