256层CT冠状动脉成像在老年患者冠状动脉旁路移植术后桥血管评价中的应用

Application of 256-slice CT coronary angiography in postoperative evaluation of graft patency after coronary artery bypass grafting in elderly patients

目的探讨256层CT冠状动脉(冠脉)成像(CTA)在老年患者冠脉旁路移植(CABG)术后桥血管评价中的应用价值。方法随机选取2016年5月至2018年5月在我院进行CABG术后随访的老年患者30例,同期行冠脉造影(CAG)及CTA对桥血管通畅性进行评价。以CAG结果为金标准,对CTA在评价桥血管通畅性的意义进行评估。结果选择性CAG观察到桥血管共82支。(1)动脉桥31支,包括:原位左乳内动脉(LIMA)→左前降支(LAD)桥27支,原位右乳内动脉(RIMA)→LAD桥1支,主动脉(AO)→LIMA→LAD 1支,以及AO→桡动脉(RA)→右冠状动脉(RCA)桥2支;(2)大隐静脉桥(SVG)51支,包括:AO→SVG→LAD桥9支、AO→SVG→回旋支(LCX)桥20支,以及AO→SVG→RCA桥22支。其中动脉桥通畅28/31支(90.3%),闭塞3支(9.7%)。静脉桥通畅34/51支(66.7%),狭窄11支(21.6%),闭塞6支(11.8%)。CTA观察到桥血管共87支。以选择性CAG结果为标准,CTA评价桥血管的总敏感性、特异性、和Kappa值分别为95.1%、97.6%、和0.93。通畅血管评价时,CTA敏感性、特异性、和Kappa值分别为96.8%、95.0%、和0.90,在狭窄病变评价时,分别为81.8%、97.2%、和0.79;闭塞病变评价时为100.0%、98.6%、和0.94。结论256层CTA桥血管检查可准确评价桥血管状况,具备无创、简便易行、低风险等优势,在老年患者CABG术后桥血管通畅性评价中推荐优先选用。

Objective To investigate the value of 256-slice CT coronary angiography(CTA)in evaluating graft patency after coronary artery bypass grafting(CABG)in elderly patients.Methods A total of 30 elderly patients under follow-up after CABG surgery in our hospital from May 2016 to May 2018 were randomly selected.During the same period,coronary angiography(CAG)and 256-slice CTA were performed to evaluate the patency of grafts.The diagnostic efficacy of CTA in evaluating the patency of bypass grafts was assessed by using CAG results as the gold standard.Results In all,82 grafts were observed on CAG,of which 31 were arterial grafts and 51 were saphenous vein grafts(SVG).Arterial grafts involved 27 original left internal mammary arteries(LIMA)→left anterior descending branch(LAD)grafts,1 original right internal mammary artery(RIMA)→LAD graft,1 aorta(AO)→LIMA→LAD graft,and 2 AO→radial arteries(RA)→right coronary artery(RCA)grafts.Venous grafts involved 9 AO→SVG→LAD grafts,20 AO→SVG→left circumflex artery(LCX)grafts,and 22 AO→SVG→RCA grafts.CAG results showed that 28 arterial grafts were unobstructed with a patency rate of 90.3%,while 3 arterial grafts(9.7%)were occluded.Meanwhile,34 venous grafts were unobstructed with a patency rate of 66.7%,11 venous grafts(21.6%)had stenosis and 6 grafts(11.8%)were occluded.A total of 87 grafts were observed by using CTA.Based on the results from CAG,the overall sensitivity,specificity and Kappa value of CTA for the assessment of grafts were 95.1%,97.6%and 0.93,respectively.The sensitivity,specificity and Kappa value of CTA were 96.8%,95.0%and 0.90 for assessing unobstructed grafts,81.8%,97.2%and 0.79 for assessing stenosed grafts,and 100%,98.6%,and 0.94 for assessing occluded grafts,respectively.Conclusions 256-slice CT coronary angiography can be used to accurately evaluate graft status and possesses advantages such as non-invasiveness,simplicity and low risk.Therefore,it should be recommended as the first choice in the evaluation of graft patency after CABG in elderly patients.