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Non-invasive computed tomography angiography in the assessment of coronary stent patency: an Australian experience

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Abstract:

Abstract Background:

This study aimed to evaluate the feasibility and accuracy of 16-slice computed tomography (CT) in the assessment of coronary stent patency. CT coronary angiography (CA) has a high degree of accuracy in the assessment of coronary artery disease compared with invasive selective CA. However, its accuracy in the evaluation of stent patency is not well investigated. Methods:

We conducted a retrospective observational study of paired CT coronary angiography (CT–CA) and invasive fluoroscopic coronary angiography (FCA) in 37 patients with 47 coronary stents. CT–CA was carried out with an electrocardiogram-gated 16-slice CT (LightSpeed-16, General Electric (GE), WI, USA). Two CT reporters, blinded to the FCA findings, assessed CT images for stent patency. A cardiologist blinded to CT findings reported FCA. FCA was regarded as the reference standard. Results:

A CT–CA could assess 45 of 47 coronary stents (96%). Non-assessable stents on CT–CA were due to motion artefacts and stent-blooming effects. Of those 45 assessable stents, CT–CA correctly identified five out of seven stents with binary in-stent restenosis (ISR) and 37 of 38 stents without binary ISR. The sensitivity and specificity of 16-slice CT in the evaluation of coronary stents for binary ISR were 71% (95% confidence interval (CI) (29%, 96%)) and 97% (95%CI (86%, 100%)), respectively, exclusive of non-assessable stents. The positive and negative predictive values of 16-slice CT were 83% (95%CI (36%, 100%)) and 95% (95%CI (83%, 99%)), respectively. Conclusion:

Sixteen-slice CT has a low sensitivity, but very a high specificity when compared with FCA in the evaluation of coronary stents for ISR.

Keywords: in-stent restenosis; percutaneous coronary intervention

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1445-5994.2007.01363.x

Affiliations: 1: Centre for Cardiovascular Therapeutics, Western Hospital 2: Department of Radiology, Western Hospital 3: Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, UK 4: Department of Cardiology, Austin Health 5: Department of Clinical Epidemiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia

Publication date: June 1, 2007

bsc/imj/2007/00000037/00000006/art00003
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