多层螺旋CT冠状动脉成像在急性心肌梗死介入诊疗中疗效评估及术后左心室重构的诊断价值分析

The value of multi-slice spiral CT coronary angiography in evaluating the curative effect of interventional diagnosis and treatment of acute myocardial infarction and diagnosing postoperative left ventricular remodeling

目的探讨多层螺旋CT冠状动脉成像(CTCA)在急性心肌梗死介入诊疗中疗效评估及术后左心室重构的诊断价值。方法我院行冠状动脉介入治疗的急性心肌梗死患者80例,均行CTCA、冠状动脉造影(CAG)检查,评估其影像特点,同时依据两种影像学检查方法对患者病情进行评估,对比两种诊断方法的差异。结果 80例患者经CTCA检查共评价710节段血管,正常500段(70. 42%),轻度狭窄74段(10. 42%),中度狭窄69段(9. 72%),重度狭窄至完全闭塞67段(9. 44%);CAG共评价710节段血管,正常504段(70. 99%),轻度狭窄75段(10. 56%),中度狭窄67段(9. 44%),重度狭窄至完全闭塞64段(9. 01%),两种方法诊断结果差异无统计学意义(P> 0. 05)。以CAG为金标准,CTCA诊断支架再狭窄的灵敏度、特异度、准确度、阳性预测值、阴性预测值、kappa值分别为98. 02%、97. 09%、97. 75%、98. 80%、95. 24%、0. 946;两种方法下左心室重构参数比较差异无统计学意义(P> 0. 05)。结论 CTCA在急性心肌梗死介入诊疗中疗效评估方面有重要价值,能有效评估其支架再狭窄程度及左心室重构情况,值得在临床推广应用。

Objective To analyze the value of multi-slice spiral CT coronary angiography(CTCA)in evaluating the curative effect of interventional diagnosis and treatment of acute myocardial infarction(AMI)and diagnosing postoperative left ventricular remodeling.M ethods Eighty patients with AMI treated with coronary intervention in our hospital were enrolled in the study.All patients were examined by CTCA and coronary angiography(CAG).The imaging features were evaluated.The condition of patients was evaluated by the two imaging methods.The differences between the two methods were compared.Results In the 80 patients,710 segments of blood vessels were evaluated by CTCA and CAG.In CTCA examination,there were 500 normal segments(70.42%),7 4 segments with mild stenosis(10.42%),69 segments with moderate stenosis(9.72%)and 67 segments from severe stenosis to complete occlusion(9.44%).In CAG examination,there were 504 normal segments(70.99%),75 segments with mild stenosis(10.5 6%),67 segments with moderate stenosis(9.44%)and 64 segments from severe stenosis to complete occlusion(9.0 1%).There were no significant differences between the two m ethods(P>0.05).With CAG as the golden standard,the sensitivity,specificity,accuracy,positive predictive value,negative predictive value and kappa value of CTCA in diagnosing stent restenosis were 98.0 2%,97.0 9%,97.7 5%,98.80%,95.24%and 0.946,respectively.There was no significant difference in left ventricular remodeling parameters between the two methods(P>0.05).Conclusion CTCA is of great value in the evaluation of the interventional treatment of AML It can effectively evaluate the degree of stent restenosis and left ventricular remodeling.