64排螺旋CT血管成像评价冠状动脉PCI后支架内再狭窄的研究

Review of in-stent restenosis after coronary PCI by using 64-slice spiral computed tomography angiography

目的评价64排螺旋CT(64-SSCT)诊断支架内再狭窄的价值,为探索经皮冠状动脉介入治疗(PCI)后无创影像随访技术提供依据。方法选取2012年11月至2018年2月于北戴河疗养院住院支架植入术后3～18个月的患者290例,64-SSCT检查后一周行冠状动脉造影术(CAG);应用SPSS 20.0软件进行分析,以CAG为"金标准"计算64排螺旋CT血管成像(64-SCTA)诊断PCI后支架内再狭窄的灵敏度、特异度、阳性预测值、阴性预测值和诊断比值比,以1-特异度为横坐标,灵敏度为纵坐标绘制ROC曲线,计算曲线下面积AUC值。结果 64-SSCT诊断支架内再狭窄的灵敏度为0.86(0.76,0.92),特异度为0.95(0.92,0.97),阳性似然比为16.41(10.61,25.39),阴性似然比为0.15(0.09,0.26),诊断比值比为108.90(49.88,237.82)和AUC值为0.90(0.86,0.95)。结论 64-SSCT能够较好的显示PCI后支架内及支架周边冠状动脉是否有再狭窄,是PCI后随访的有效检查方法。

Objective To review the value of 64-slice spiral computed tomography(64-SSCT)in diagnosis of in-stent restenosis(ISR),and provide reference for the exploration of noninvasive imaging follow-up technology after PCI.Methods The patients(n=290)treated in Beidaihe Rehabilitation and Rehabilitation Center were chosen from Nov.2012 to Feb.2018,and given coronary angiography(CAG)after stent implantation for 3 months to 18 months and after examination of 64-SSCT for 1 week.SPSS 20.0 software was used in analysis,and CAG was taken as gold standard to calculate the sensitivity,specificity,positive predictive value,negative predictive value and diagnostic odds ratio(OR)of 64-slice spiral computed tomography angiography(64-SCTA)in the diagnosis of ISR after PCI.The curve of receiver operating characteristic(ROC)was drawn with 1-specificity as abscissa and sensitivity as ordinate,and value of area under curve(AUC)was calculated.Results The sensitivity was 0.86(0.76,0.92),specificity was 0.95(0.92,0.97),positive likelihood ratio was 16.41(10.61,25.39),negative likelihood ratio was 0.15(0.09,0.26),diagnostic OR was 108.90(49.88,237.82),and value of AUC was 0.90(0.86,0.95).Conclusion 64-SSCT can well show whether there are ISR or peripheral coronary restenosis after PCI,which is an effective method for following up after PCI.