Dual source coronary computed tomography angiography for detecting in-stent restenosis
Heart , Volume 94 - Issue 7 p. 848- 854
Objective: To evaluate the performance of dual source CT coronary angiography (DSCT-CA) in the detection of instent restenosis (≥50% luminal narrowing) in symptomatic patients referred for conventional angiography (CA). Design/patients: 100 patients (78 males, age 62 (SD 10)) with chest pain were prospectively evaluated after coronary stenting. DSCT-CA was performed before CA. Setting: Many patients undergo coronary artery stenting; availability of a non-invasive modality to detect in-stent restenosis would be desirable. Results: Average heart rate (HR) was 67 (SD 12) (range 46-106) bpm. There were 178 stented lesions. The interval between stenting and inclusion in the study was 35 (SD 41) (range 3-140) months. 39/100 (39%) patients had angiographically proven restenosis. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of DSCT-CA, calculated in all stents, were 94%, 92%, 77% and 98%, respectively. Diagnostic performance at HR <70 bpm (n = 69; mean 58 bpm) was similar to that at HR ≥70 bpm (n = 31; mean 78 bpm); diagnostic performance in single stents (n = 95) was similar to that in overlapping stents and bifurcations (n = 83). In stents ≥3.5 mm (n = 78), sensitivity, specificity, PPV, NPV were 100%; in 3 mm stents (n = 59), sensitivity and NPV were 100%, specificity 97%, PPV 91%; in stents ≤2.75 mm (n = 41), sensitivity was 84%, specificity 64%, PPV 52%, NPV 90%. Nine stents ≤2.75 mm were uninterpretable. Specificity of DSCT-CA in stents ≥3.5 mm was significantly higher than in stents ≤2.75 mm (OR = 6.14; 99%CI: 1.52 to 9.79). Conclusion: DSCT-CA performs well in the detection of in-stent restenosis. Although DSCT-CA leads to frequent false positive findings in smaller stents (≤2.75 mm), it reliably rules out in-stent restenosis irrespective of stent size.
|Organisation||Erasmus MC: University Medical Center Rotterdam|
Pugliese, F, Weustink, A.C, van Mieghem, C.A.G, Alberghina, F, Otsuka, M, Meijboom, W.B, … de Feyter, P.J. (2008). Dual source coronary computed tomography angiography for detecting in-stent restenosis. Heart, 94(7), 848–854. doi:10.1136/hrt.2007.126474