CTA和冠状动脉造影对冠心病内支架植入术后再狭窄的评估价值

Comparative analysis of CT coronary imaging and coronary angiography in the evaluation of restenosis after stenting in coronary heart disease

目的探讨CT冠状动脉血管成像(CT coronary angiography,CTA)和冠状动脉造影(coronary angiography,CAG)对冠心病内支架植入术后支架内再狭窄(in stent restenosis,ISR)诊断的临床价值。方法选取我院经皮冠状动脉介入治疗的126例冠心病患者进行分析,先后经CTA和CAG检查,两项检查间隔时间小于3个月,以CAG为金标准,支架内再狭窄定义为支架腔狭窄程度≥50%,对CTA的诊断情况进行分析和探讨。结果CAG检查植入的160枚内支架中27枚出现术后再狭窄,占比16.88%,CTA检查内支架术后再狭窄28枚,占比17.50%,以CAG为金标准,CTA发现24枚狭窄4枚漏、误诊。经检验其灵敏度88.89%,特异度96.99%,准确率95.63%,Kappa值0.862。CAG对各级冠状动脉ISR的检查结果:在后降支9枚,右冠状动脉7枚,左回旋支7枚,左前降支3枚,左主干1枚。CTA对其诊断准确率分别是93.25%、95.34%、96.84%、95.68%、100%。Friedman检验结果可知,CTA和CAG对ISR的程度无区别,差异无统计学意义(P>0.05)。结论经皮冠状动脉介入治疗的冠心病患者ISR应用CTA进行诊断具有较高的准确率,在病变部位和狭窄程度的诊断方面和CAG的结果高度相似。

Objective Coronary angiography(CT coronary angiography,CTA)and coronary Coronary angiography CAG were used to investigate the coronary artery restenosis after in stent restenosis(ISR)to evaluate the clinical value.Methods 126 patients with coronary heart disease who underwent percutaneous coronary intervention(PCI)in our hospital were studied.CTA and CAG examinations were performed successively,and the interval between the two examinations was less than 3 months.With coronary angiography as the gold standard,intrastent restenosis was defined as the degree of stent stenosis≥50%.The diagnosis of CTA was analyzed and discussed.Results Coronary angiography results were as follows:Among the 160 stents,27 showed restenosis after surgery,accounting for 16.88%;CTA results:showed 28 stents,accounting for 17.50%;Among them,24 were both detected;4 were misdiagnosed/missed.The sensitivity,specificity,accuracy and Kappa value were 88.89%,96.99%,95.63%and 0.862 respectively.The results of coronary angiography for restenosis after stenting were as follows:9 in the posterior descending branch,7 in the right coronary artery,7 in the left circumferential branch,3 in the left anterior descending branch,and 1 in the left main trunk.The diagnostic accuracy of CTA was 93.25%,95.34%,96.84%,95.68%,100%,respectively.Friedman test showed that CTA and coronary angiography had no difference in the degree of restenosis after stentimplantation.Conclusion The application of CTA in the diagnosis of restenosis after stenting in patients with coronary heart disease after percutaneous coronary intervention has a high diagnostic degree,and the diagnosis of lesion site and degree of stenosis is highly similar to that of coronary angiography.