CTA和冠状动脉造影对冠心病支架置入术后再狭窄的评估价值对比分析

Comparative Analysis of Evaluated Value of CTA And Coronary Angiography on Restenosis After Coronaryheart Disease Stent Implantation

目的比较CT冠脉造影(CTA)和冠状动脉造影(CAG)对冠心病(CHD)支架置入术后再狭窄(ISR)检查结果并分析CTA诊断价值。方法选取2018年6月至2019年6月我院接受PCI治疗的CHD患者127例为样本进行横断面研究,均在CTA检查后3个月内行CAG检查并分别判断ISR发生情况,以CAG结果为“金标准”葑析CTA诊断价值。结果CAG检查显示158枚支架发生ISR者26枚(16.46%),CTA显示ISR发生27枚,两者共同检出23枚,CTA漏诊3枚,误诊4枚,诊断灵敏度为88.46%,特异度为98.97%,准确率为95.57%,一致性Kappa值为0.841;各级冠脉ISR发生率为LM 1枚(5.88%)、LAD 3枚(1034%)、LCX 7枚(22.58%)、RCA 6枚(15.79%)和PDA9枚(20.93%),CTA对LM、LAD、LCX、RCA和PDA中ISR诊断准确率分别为100.00%、96.5%、96.77%、94.74%和93.02%;CTA与CAG对冠脉再狭窄程度检查结果差异未见统计学意义(P>0.05)。结论CTA用于CHD患者PCI术后ISR诊断具有较高准确率,且对病灶位置和狭窄程度判断与CAG检查基本一致。

Objective To compare the examination results of CT coronary angiography(CTA) and coronary angiogra phy(CAG) on in stent restenosis(ISR) after coronary heart disease(CHD) stent im plantation and analyze the diagnostic value of CTA.Methods From June 2018 to June 2019,127 patients with CHD who underwent PCI treatment in our hospital were selected as samples for cross-sectional study.All patients underwent CAG examination within 3 months after CTA examination and the occurrence of ISR was judged.The CAG results were taken as gold standard to analyzes the diagnostic value of CTA.Results CAG examination revealed there were 26 stents(16.46%) with ISR among 158 stents,and CTA showed there were 27 stents with ISR.And 23 stents were both detected,and there were 3 stents of missed diagnosis and 4 stents of misdiagnosis by CTA,and the diagnostic sensitivity,specificity,accuracy rate and consistency Kappa value were 88.46%,96.97%,95.57% and 0.841.The incidence rate of coronary ISR at all levels showed there was 1 stent of LM(5.88%),3 stents of LAD(10.34%),7 stents of LCX(22.58%),6 stents of RCA(15.79%) and 9 stents of PDA(20.93%),and the diagnostic accuracy rates of CTA for LM,LAD,LCX,RCA and PDA were 100.00%,96.55%,96.77% 94.74% and 93.02% respectively.There were no statistically significant differences in the examination results of coronary restenosis by CTA or CAG(P>0.05).Conclusion CTA has a high accuracy rate in the diagnosis of ISR after PCI in CHD patients,and its judgments of lesion location and stenosis degreeare basically consistent with the CAG examination.