Comparison of Multi-Detector Computed Tomography Coronary Angiography with Invasive Coronary Angiography in Patients with Coronary Artery Disease

Öz

Aim: This study aimed to investigate the accuracy of multi-detector computed tomography (MDCT) coronary angiography via comparing with the invasive coronary angiography (ICA).
Material and Method: Sixty-three patients (42 male, 21 female) that presented with chest pain and underwent MDCT, followed by ICA within one month were evaluated. The age of the patients ranged from 35 to 75 years. The coronary arteries were examined over a total of 15 segments according to American Heart Association classification. The detected stenoses of coronary artery were divided into four groups; non-obstructive (1-49%), significant stenosis (50-74%), high-grade stenosis (75-99%), and occlusion (100%). Segment-based and patient-based analyses were performed. The results of MDCT coronary angiography and ICA were compared. The sensitivity, specificity, positive predictive and negative predictive values were calculated by comparing the MDCT coronary angiography and ICA data.
Results: In the segment-based analysis, regardless of the stenosis rate, the sensitivity was 90.8%, specificity was 95%, positive predictive value was 82.7% and negative predictive value was 97.5%. In the segment-based analysis regarding the detection of ≥ 50% stenosis, the sensitivity specificity, positive predictive and negative predictive values were 89.6%, 95.9%, 59.0%, and 99.2%, respectively. In the patient-based analysis regarding the detection of ≥ 50% stenosis, the sensitivity was 96.2%, specificity was 66.6%, positive predictive value was 68.4%, and negative predictive value was 96%.
Conclusion: MDCT coronary angiography is an examination that can be used as a non-invasive method for patients in the low and medium risk group for coronary artery disease.

Anahtar Kelimeler

• Multi-detector computed tomography
• invasive coronary angiography
• coronary artery disease

Koroner Arter Hastalığı Olan Hastalarda Çok Dedektörlü Bilgisayarlı Tomografi Koroner Anjiografi ile İnvaziv Koroner Anjiografinin Karşılaştırılması

Öz

Amaç: Bu çalışma, çok dedektörlü bilgisayarlı tomografi (ÇDBT) koroner anjiyografinin doğruluğunu, invazif koroner anjiyografi (İKA) ile karşılaştırarak incelemeyi amaçladı.
Materyal ve Metot: Göğüs ağrısı ile başvurup ÇDBT koroner anjiografi çekilen ve bunu takiben bir ay içerisinde İKA yapılan hastalar çalışmaya alındı. Çalışma grubumuzda yaşları 35-75 arasında değişen 42’si erkek, 21’i kadın toplam 63 hasta vardı. Koroner arterler American Heart Association sınıflamasına göre toplam 15 segment üzerinden incelendi. Tespit edilen koroner arter stenozları 4 gruba ayrıldı; non-obstrüktif (%1–49), anlamlı stenoz (%50–74), yüksek dereceli stenoz (%75–99) ve oklüzyon (%100). ÇDBT sonuçları İKA ile karşılaştırılarak segment bazlı ve hasta bazlı analizler yapıldı. Elde ettiğimiz veriler İKA sonuçları ile kıyaslanarak sensivite, spesifite, pozitif prediktif değer ve negatif prediktif değerleri hesaplandı.
Bulgular: Çalışmamızda segment bazlı analizde stenoz oranlarına bakılmaksızın yapılan değerlendirmede sensitivite %91.5, spesifite %95, pozitif prediktif değer %84.7 ve negatif prediktif değer %97.4, segment bazlı ≥ %50 stenozları saptamada sensitivite %89.6, spesifite %95.9, pozitif prediktif değer %59.0 ve negatif prediktif değer %99.2, hasta bazlı değerlendirmelerimizde ≥ %50 stenoz tespit etmede sensitivite %96.2, spesifite %66.6, pozitif prediktif değer %68.4 ve negatif prediktif değeri %96 bulduk.
Sonuç: ÇDBT koroner anjiografi, koroner arter hastalığı açısından düşük ve orta risk grubunda yer alan hastalarda non-invaziv bir yöntem olarak kullanılabilir bir tetkiktir.

Anahtar Kelimeler

• Multi-dedektör bilgisayarlı tomografi
• invaziv koroner anjiografi
• koroner arter hastalığı

Kaynakça

1. 1. American Heart Association. Heart Disease and Stroke Statistics 2005 Update.Dallas, Texas. American Heart Association. 2005.
2. 2. Murray CJ, Lopez AD. Mortality by cause for eight regions of the world: GlobalBurden of Disease Study. Lancet 1997; 349: 1269-1276.
3. 3. American Heart Association 2002 Heart and Stroke Statistical Update. Dallas: American Heart Association. 2001.
4. 4. Kantarcı M, Duran C, Durur I, et al. Multidetector CT angiography in the evaluation of coronary arteries: technique, anatomy and variations. Computerized tomography study 2005; 8: 89-98.
5. 5. Taylor AJ, Cerqueira M, Hodgson JM, et al. ACCF/ SCCT/ ACR/ AHA/ ASE/ASNC/ NASCI/ SCAI/ SCMR 2010 appropriate use criteria for cardiac computedtomography. J Am Coll Cardiol. 2010; 56: 1864-1894.
6. 6. Davis K, Kennedy JW, Kemp HG Jr, et al. Complications of coronary arteriography from the Collaborative Study of Coronary Artery Surgery (CASS). Circulation. 1979 Jun;59(6):1105–12.
7. 7. Johnson LW, Lozner EC, Johnson S, et al. Coronary arteriography 1984–1987: a report of the Registry of the Society for CardiacAngiography and Interventions. I. Results and complications Cathet Cardiovasc Diagn.1989 May;17(1):5–10.
8. 8. Ohnesorge B, Flohr T, Becker C, et al. Cardiacimaging by means of electrocardiographically gated multisection spiral CT: initialexperience. Radiology. 2000; 217:564-71.

9. 9. Giesler T, Baum U, Ropers D, et al. Noninvasive visuallization of coronary arteriesusing contrast-enhanced multidedector CT: influence of heart rate on image quality andstenosis dedection. AJR Am J Roentgenol 2002; 179:911-916.
10. 10. Abdulla J, Abildstrom SZ, Gotzsche O, et al. 64-multislice detector computed tomography coronary angiography as potential alternative to conventional coronary angiography: a systematic review and meta-analysis. European Heart Journal 2007; 28: 3042-3050.
11. 11. Hamon, M., Biondi-Zoccai, G. G., Malagutti, P., et al. Diagnostic performance of multislice spiral computed tomography of coronary arteries as compared with conventional invasive coronary angiography: a meta-analysis. Journal of the American College of Cardiology, 2006; 48(9), 1896-1910.
12. 12. Ehara M, Surmely JF, Kawai M et al. Diagnostic accuracy of 64-slice computedtomography for detecting angiographically significant coronary artery stenosis in anunselected consecutive patient population: comparison with conventional invasiveangiography. Circ J. 2006; 70: 564-71.
13. 13. Scheffel H, Leschka S, Plass A et al. Accuracy of 64-slice computed tomographyfor the preoperative detection of coronary artery disease in patients with chronic aorticregurgitation. Am J Cardiol. 2007;100:701-706.
14. 14. Chao SP, Law WY, Kuo CJ, et al. Diagnostic accuracy of 256-row computed tomographic angiography with invasive coronary angiography in patients with suspected coronary artery disease. European Heart Journal 2010; doi:10:1093.
15. 15. Miller JM, Rochitte CE, Dewey M, et al. Diagnostic performance of coronaryangiography by 64-row CT. N Engl J Med. 2008;359:2324-2336.
16. 16. Leber AW, Knez A, von Ziegler F, et al. Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography: a comparative study with quantitative coronary angiography and intravascular ultrasound. J Am Coll Cardiol 2005; 46:147-54.
17. 17. Budoff, M. J., Dowe, D., Jollis, J. G., et al. Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. Journal of the American College of Cardiology, 2008; 52(21), 1724-1732.
18. 18. Lutgens E, van Suylen RJ, Faber BC, et al. Atherosclerotic plaque rupture: local orsystemic process? Arterioscler Thromb Vasc Biol. 2003; 23: 2123–2130.