BACKGROUND: Coronary computed tomography angiography (CTA) is a well-established diagnostic tool for coronary artery disease (CAD). However, coronary segments with prior stent implantation visualized with CTA may have limited evaluation and reduced accuracy. OBJECTIVE: We assessed the incremental value of stress myocardial CT perfusion (CTP) over anatomical assessment by coronary CTA alone in patients with stents, using quantitative invasive coronary angiography (≥50%) as reference. METHODS: Forty-six patients (56.9 ± 7.2 years; 28 men) referred to invasive coronary angiography were evaluated, combining coronary CTA and dipyridamole stress myocardial CTP with 64 detector-row CT. Coronary CTA was evaluated for ≥50% coronary stenosis, and myocardial CTP was used to potentially reclassify coronary territories, including those with stents and poorly evaluated stents because of artifacts. RESULTS: We evaluated 138 coronary territories, 62 with ≥1 stent. From these, 21 (34%) territories had adequately evaluated stents, 28 (45%) had limitedly evaluated stents still allowing diagnosis, and 13 (21%) had inadequately evaluated stents (no luminal assessment possible). Sensitivity, specificity, positive predictive value, negative predictive value and accuracy for coronary CTA in stent territories were, respectively, 85%, 77%, 87%, 74%, and 81%, and the combined use of coronary CTA and myocardial CTP were 88%, 95%, 97%, 81%, and 91% (P = 0.0292). In territories with impaired stent evaluation (limited or inadequate), the diagnostic performance of coronary CTA alone was 83%, 72%, 79%, 76% and 77%, and combined with myocardial CTP were 87%, 94%, 95%, 85%, and 91% (P = 0.036). CONCLUSION: The combined evaluation of coronary CTA and stress myocardial CTP improved the diagnostic accuracy for the detection of significant obstructive CAD in patients with stents.
BACKGROUND: Coronary computed tomography angiography (CTA) is a well-established diagnostic tool for coronary artery disease (CAD). However, coronary segments with prior stent implantation visualized with CTA may have limited evaluation and reduced accuracy. OBJECTIVE: We assessed the incremental value of stress myocardial CT perfusion (CTP) over anatomical assessment by coronary CTA alone in patients with stents, using quantitative invasive coronary angiography (≥50%) as reference. METHODS: Forty-six patients (56.9 ± 7.2 years; 28 men) referred to invasive coronary angiography were evaluated, combining coronary CTA and dipyridamole stress myocardial CTP with 64 detector-row CT. Coronary CTA was evaluated for ≥50% coronary stenosis, and myocardial CTP was used to potentially reclassify coronary territories, including those with stents and poorly evaluated stents because of artifacts. RESULTS: We evaluated 138 coronary territories, 62 with ≥1 stent. From these, 21 (34%) territories had adequately evaluated stents, 28 (45%) had limitedly evaluated stents still allowing diagnosis, and 13 (21%) had inadequately evaluated stents (no luminal assessment possible). Sensitivity, specificity, positive predictive value, negative predictive value and accuracy for coronary CTA in stent territories were, respectively, 85%, 77%, 87%, 74%, and 81%, and the combined use of coronary CTA and myocardial CTP were 88%, 95%, 97%, 81%, and 91% (P = 0.0292). In territories with impaired stent evaluation (limited or inadequate), the diagnostic performance of coronary CTA alone was 83%, 72%, 79%, 76% and 77%, and combined with myocardial CTP were 87%, 94%, 95%, 85%, and 91% (P = 0.036). CONCLUSION: The combined evaluation of coronary CTA and stress myocardial CTP improved the diagnostic accuracy for the detection of significant obstructive CAD in patients with stents.
Authors: Tiago A Magalhães; Satoru Kishi; Richard T George; Armin Arbab-Zadeh; Andrea L Vavere; Christopher Cox; Matthew B Matheson; Julie M Miller; Jeffrey Brinker; Marcelo Di Carli; Frank J Rybicki; Carlos E Rochitte; Melvin E Clouse; João A C Lima Journal: J Cardiovasc Comput Tomogr Date: 2015-03-21
Authors: Michael A Speidel; Courtney L Bateman; Yinghua Tao; Amish N Raval; Timothy A Hacker; Scott B Reeder; Michael S Van Lysel Journal: Med Phys Date: 2013-01 Impact factor: 4.071
Authors: Yinghua Tao; Guang-Hong Chen; Timothy A Hacker; Amish N Raval; Michael S Van Lysel; Michael A Speidel Journal: Med Phys Date: 2014-07 Impact factor: 4.071
Authors: Quynh A Truong; Paul Knaapen; Gianluca Pontone; Daniele Andreini; Jonathon Leipsic; Patricia Carrascosa; Bin Lu; Kelley Branch; Subha Raman; Stephen Bloom; James K Min Journal: J Nucl Cardiol Date: 2014-12-31 Impact factor: 5.952
Authors: Marcelo Souto Nacif; Yixun Liu; Jianhua Yao; Songtao Liu; Christopher T Sibley; Ronald M Summers; David A Bluemke Journal: J Cardiovasc Comput Tomogr Date: 2012-12-04
Authors: Tiago Augusto Magalhães; Roberto Caldeira Cury; Rodrigo Julio Cerci; José Rodrigues Parga Filho; Ilan Gottlieb; Marcelo Souto Nacif; Ibraim Masciarelli Pinto; Carlos Eduardo Rochitte; Fabio Vilas-Boas; Paulo R Schvartzman Journal: Arq Bras Cardiol Date: 2019-11-04 Impact factor: 2.000