CT Angiography and Myocardial CT Perfusion in Patients with Coronary Stents: Prospective Intraindividual Comparison with Conventional Coronary Angiography.
J Am Coll Cardiol. 2013 Jun 14;
Authors: Rief M, Zimmermann E, Stenzel F, Martus P, Stangl K, Greupner J, Knebel F, Kranz A, Schlattmann P, Laule M, Dewey M
OBJECTIVE: To determine whether adding myocardial CT perfusion (CTP) to CT angiography (CTA) improves diagnostic performance for coronary stents.
BACKGROUND: CTA of coronary stents has been limited by nondiagnostic studies caused by metallic stent material and coronary motion.
METHODS: CTA and CTP were performed in 91 consecutive patients with stents before quantitative coronary angiography, the reference standard for obstructive stenosis (≥50%). If a coronary stent or vessel was nondiagnostic on CTA, adenosine stress CTP in the corresponding myocardial territory was read for combined CTA/CTP.
RESULTS: Patients had an average of 2.5±1.8 coronary stents (1 to 10), with a diameter of 3.0±0.5 mm. Significantly more patients were nondiagnostic for stent assessment by CTA (22%; mainly due to metal artifacts (75%) or motion [25%]) versus CTP (1%, P<0.001; severe angina precluded CTP in one case). The per-patient diagnostic accuracy of CTA/CTP for stents (87%; 95% confidence interval, 78-93%) was significantly higher than that of CTA alone (71%; 61-80%; P<0.001), mainly because nondiagnostic examinations were significantly reduced (P<0.001). In the analysis of any coronary artery disease, diagnostic accuracy and nondiagnostic rate were also significantly improved by the addition of CTP (P<0.001). CTA/CTP (7.9±2.8 mSv) had a significantly lower effective radiation dose than angiography (9.5±5.1 mSv; P=0.005). The area under the receiver-operating-characteristic curve for CTA/CTP (0.82; 0.69-0.95) was superior to that for CTA (0.69; 0.57-0.82; P<0.001) in identifying patients requiring stent revascularization.\ CONCLUSIONS: Combined coronary CTA and myocardial CTP improves diagnosis of CAD and in-stent restenosis in patients with stents compared with CTA alone.
PMID: 23792193 [PubMed - as supplied by publisher]