Multislice spiral computed tomography for the evaluation of stent patency after left main coronary artery stenting: a comparison with conventional coronary angiography and intravascular ultrasound.
BACKGROUND
Surveillance conventional coronary angiography (CCA) is recommended 2 to 6 months after stent-supported left main coronary artery (LMCA) percutaneous coronary intervention due to the unpredictable occurrence of in-stent restenosis (ISR), with its attendant risks. Multislice computed tomography (MSCT) is a promising technique for noninvasive coronary evaluation. We evaluated the diagnostic performance of high-resolution MSCT to detect ISR after stenting of the LMCA.


RESULTS
Seventy-four patients were prospectively identified from a consecutive patient population scheduled for follow-up CCA after LMCA stenting and underwent MSCT before CCA. Until August 2004, a 16-slice scanner was used (n = 27), but we switched to the 64-slice scanner after that period (n = 43). Patients with initial heart rates > 65 bpm received beta-blockers, which resulted in a mean periscan heart rate of 57 +/- 7 bpm. Among patients with technically adequate scans (n = 70), MSCT correctly identified all patients with ISR (10 of 70) but misclassified 5 patients without ISR (false-positives). Overall, the accuracy of MSCT for detection of angiographic ISR was 93%. The sensitivity, specificity, and positive and negative predictive values were 100%, 91%, 67%, and 100%, respectively. When analysis was restricted to patients with stenting of the LMCA with or without extension into a single major side branch, accuracy was 98%. When both branches of the LMCA bifurcation were stented, accuracy was 83%. For the assessment of stent diameter and area, MSCT showed good correlation with intravascular ultrasound (r = 0.78 and 0.73, respectively). An intravascular ultrasound threshold value > or = 1 mm was identified to reliably detect in-stent neointima hyperplasia with MSCT.


CONCLUSIONS
Current MSCT technology, in combination with optimal heart rate control, allows reliable noninvasive evaluation of selected patients after LMCA stenting. MSCT is safe to exclude left main ISR and may therefore be an acceptable first-line alternative to CCA.
Van Mieghem
Carlos A G
CA
Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
Cademartiri
Filippo
F
Mollet
Nico R
NR
Malagutti
Patrizia
P
Valgimigli
Marco
M
Meijboom
Willem B
WB
Pugliese
Francesca
F
McFadden
Eugene P
EP
Ligthart
Jurgen
J
Runza
Giuseppe
G
Bruining
Nico
N
Smits
Pieter C
PC
Regar
Evelyn
E
van der Giessen
Willem J
WJ
Sianos
Georgios
G
van Domburg
Ron
R
de Jaegere
Peter
P
Krestin
Gabriel P
GP
Serruys
Patrick W
PW
de Feyter
Pim J
PJ
D000319:Adrenergic beta-Antagonists / Q000494:pharmacology; D000368:Aged; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000503:physiopathology / Q000628:therapy; D023903:Coronary Restenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology; D005260:Female; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015607:Stents; D036542:Tomography, Spiral Computed / Q000379:methods*; D018084:Ultrasonography, Interventional
D000319:Adrenergic beta-Antagonists