SEMPTOMATİK HASTALARDA İNVAZİV KORONER ANJİYOGRAFİ İLE KARŞILAŞTIRILDIĞINDA KORONER BİLGİSAYARLI TOMOGRAFİK ANJİYOGRAFİNİN TANISAL PERFORMANSI: UZUN DÖNEM PROGNOSTİK ETKİLER

Öz

Amaç: Bu araştırmada, stabil semptomatik hastalarda 64 çok-kesitli koroner bilgisayarlı tomografik anjiyografinin (ÇKBTA) tanısal doğruluğu ile koroner arter hastalığı (KAH) ciddiyeti, kardiyovasküler risk skorları ve koroner kalsiyum skoru (KKS) arasındaki ilişkiyi incelemek amaçlanmıştır. Ayrıca, ortalama 10 yıllık takipte, tüm nedenlere bağlı mortalitenin olası prediktörlerini değerlendirdik.
Gereç ve Yöntem: Bu retrospektif, gözlemsel çalışmaya, şüpheli KAH olan ve iki hafta içinde ÇKBTA ve invaziv koroner anjiyografi yapılmış 45 hasta dahil edildi (%67 erkek, ortalama yaş 62,1±10,72 yıl). Duyarlılık, özgüllük, pozitif ve negatif kestirim değerleri (PKD ve NKD), ÇKBTA için segment ve hasta bazlı analizde hesaplandı. Toplam KKS (Agatston units [AU]) ve sistematik koroner risk değerlendirme (SCORE) skorları her hasta için hesaplandı.
Bulgular: Segment ve hasta bazlı analizde, ÇKBTA’nın NKD ve PKD sırasıyla %97 ve %100, ve %94 ve %88 idi. KKS >100 AU olan grup daha yüksek ciddi KAH insidansı ile ilişkili bulundu (OR=4,88, 95% CI 1,62–14,68 p<0,001). KKS ile SCORE risk değerleri arasında önemli pozitif korelasyon mevcuttu (r=0,669, p<0,001). Takipte, 6 (%13,3) hasta öldü. KKS, SCORE risk değeri ve yaş birlikte, ortalama 10 yıllık takipte tüm nedenlere bağlı ölüm tahminini önemli ölçüde iyileştirdi (AUC=0,833, 95% CI 0,693–0,974, p=0,009).
Sonuç: 64-ÇKBTA, ciddi KAH’ı dışlamak veya belirlemek için yüksek tanısal doğruluğa sahiptir. Ayrıca, KKS ve SCORE risk skoru uzun dönem mortaliteyi öngörmek ve koruyucu tedavileri iyileştirmek için değerli prognostik bilgiler sağlayabilir.

Anahtar Kelimeler

• çok kesitli bilgisayarlı tomografik anjiyografi
• koroner arter hastalığı
• mortalite
• kardiyovasküler risk

THE DIAGNOSTIC PERFORMANCE OF CORONARY COMPUTED TOMOGRAPHIC ANGIOGRAPHY COMPARED WITH INVASIVE CORONARY ANGIOGRAPHY IN SYMPTOMATIC PATIENTS: LONG–TERM PROGNOSTIC IMPLICATIONS

Öz

Objective: We aimed to investigate the diagnostic accuracy of 64-multidetector coronary computed tomographic angiography (CCTA) for stable symptomatic patients and evaluate the relationship between severity of coronary artery disease (CAD), cardiovascular risk scores, and coronary artery calcium (CAC) scores. We also assessed the possible predictors of all-cause mortality at a median of 10 years of follow-up.
Materials and Methods: This retrospective, observational study included 45 patients with suspected CAD who had undergone CCTA and invasive coronary angiography within the previous two weeks (67% male, mean age 62.1±10.72 years). Using CCTA, sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated on a segment and patient basis analysis. The total CAC (Agatston units [AU]) and systematic coronary risk evaluation (SCORE) scores were calculated for each patient.
Results: The CCTA NPV and PPV for the segment- and patient-based analyses were 97% and 100%, and 94% and 88%, respectively. CAC scores >100 AU reflected a higher incidence of significant CAD (OR=4.88, 95% CI 1.62–14.68 p<0.001), and CAC scores were significantly correlated with SCORE risk values (r=0.669, p<0.001). Ultimately, 6 patients (13.3%) died. Combined CAC and SCORE value and age significantly improved the prediction of all-cause mortality at a median of 10 years of follow-up (AUC=0.833, 95% CI 0.693–0.974, p=0.009).
Conclusion: 64-multidetector CCTA has high diagnostic accuracy for detecting or excluding significant CAD. Moreover, CAC and SCORE risk score may provide valuable prognostic information for predicting long-term mortality and improving preventive therapies.

Anahtar Kelimeler

• Multidetector computed tomography angiography
• coronary artery disease
• mortality
• cardiovascular risk

Kaynakça

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