CT血管成像联合多层螺旋CT对ST段抬高型心肌梗死患者PCI后再狭窄的诊断价值

Diagnostic value of CT angiography combined with multi-slice spiral CT for restenosis after PCI in patients with ST elevation myocardial infarction

目的探讨CT血管成像联合多层螺旋CT对ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入术(PCI)后再狭窄的诊断价值。方法观察性研究。抽取2019年10月至2022年10月河南省人民医院收治的62例STEMI患者为研究对象。所有患者均完成PCI治疗,PCI后6个月均行CT血管成像、多层螺旋CT、冠状动脉造影检查,以冠状动脉造影检查结果为金标准,分析CT血管成像联合多层螺旋CT对STEMI患者PCI后再狭窄的诊断价值。结果PCI后6个月,62例STEMI患者中发生再狭窄21例(轻度狭窄10例,中度狭窄7例,重度狭窄4例),未发生再狭窄41例。经Kappa一致性检验,CT血管成像、多层螺旋CT检查诊断STEMI患者PCI后再狭窄结果与冠状动脉造影结果的一致性均一般(Kappa=0.57、0.41,P均<0.001);CT血管成像联合多层螺旋CT对STEMI患者PCI后再狭窄的诊断结果与冠状动脉造影结果的一致性极好(Kappa=0.77,P<0.001)。CT血管成像联合多层螺旋CT检查的敏感度、阴性预测值高于CT血管成像、多层螺旋CT单独检查,差异有统计学意义(P<0.05)。CT血管成像联合多层螺旋CT对STEMI患者PCI后轻度狭窄的检出率高于CT血管成像、多层螺旋CT单独检查,差异有统计学意义(P<0.05)。结论CT血管成像联合多层螺旋CT对STEMI患者PCI后再狭窄的诊断价值显著,且可明确STEMI患者PCI后的再狭窄程度。

Objective To investigate diagnostic value of computed tomography(CT)angiography combined with multi-slice spiral CT for restenosis after percutaneous coronary intervention(PCI)in patients with ST elevation myocardial infarction(STEMI).Methods Observational research was adopted in this study.A total of 62 STEMI patients admitted to Henan Provincial People’s Hospital from October 2019 to October 2022 were selected as the research subjects.All patients completed PCI treatment;the CT angiography,multi-slice spiral CT,and coronary angiography were performed 6 months after PCI.The results of coronary angiography were used as the gold standard,the diagnostic value of CT angiography combined with multi-slice spiral CT for restenosis after PCI in STEMI patients was analyzed.Results Six months after PCI,21 of 62 STEMI patients experienced restenosis(10 cases mild stenosis,7 cases moderate stenosis,and 4 cases severe stenosis),while 41 patients did not experience restenosis.According to the Kappa consistency test,the consistency of the results of CT angiography and multi-slice spiral CT with coronary angiography in diagnosing restenosis after PCI in STEMI patients were average(Kappa=0.57,0.41;all P<0.001);the consistency between the results of CT angiography combined with multi-slice spiral CT and coronary angiography in diagnosing restenosis after PCI in STEMI patients was excellent(Kappa=0.77,P<0.001).The sensitivity and negative predictive value of CT angiography combined with multi-slice spiral CT were higher than those of CT angiography alone and multi-slice spiral CT alone,with a statistical significant difference(P<0.05).The detection rate of mild stenosis in STEMI patients after PCI by CT angiography combined with multi-slice spiral CT was higher than that by CT angiography or multi-slice spiral CT alone,with a statistical significant difference(P<0.05).Conclusions The combination of CT angiography and multi-slice spiral CT has significant diagnostic value for restenosis in STEMI patients after PCI,and can determine the degree of restenosis in STEMI patients after PCI.