Dual source coronary computed tomography angiography for detecting in-stent restenosis.
OBJECTIVE
To evaluate the performance of dual source CT coronary angiography (DSCT-CA) in the detection of in-stent restenosis (>or=50% luminal narrowing) in symptomatic patients referred for conventional angiography (CA). DESIGN/ PATIENTS: 100 patients (78 males, age 62 (SD 10)) with chest pain were prospectively evaluated after coronary stenting. DSCT-CA was performed before CA.


METHODS
Many patients undergo coronary artery stenting; availability of a non-invasive modality to detect in-stent restenosis would be desirable.


RESULTS
Average heart rate (HR) was 67 (SD 12) (range 46-106) bpm. There were 178 stented lesions. The interval between stenting and inclusion in the study was 35 (SD 41) (range 3-140) months. 39/100 (39%) patients had angiographically proven restenosis. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of DSCT-CA, calculated in all stents, were 94%, 92%, 77% and 98%, respectively. Diagnostic performance at HR <70 bpm (n = 69; mean 58 bpm) was similar to that at HR >or=70 bpm (n = 31; mean 78 bpm); diagnostic performance in single stents (n = 95) was similar to that in overlapping stents and bifurcations (n = 83). In stents >or=3.5 mm (n = 78), sensitivity, specificity, PPV, NPV were 100%; in 3 mm stents (n = 59), sensitivity and NPV were 100%, specificity 97%, PPV 91%; in stents <or=2.75 mm (n = 41), sensitivity was 84%, specificity 64%, PPV 52%, NPV 90%. Nine stents <or=2.75 mm were uninterpretable. Specificity of DSCT-CA in stents >or=3.5 mm was significantly higher than in stents <or=2.75 mm (OR = 6.14; 99%CI: 1.52 to 9.79).


CONCLUSIONS
DSCT-CA performs well in the detection of in-stent restenosis. Although DSCT-CA leads to frequent false positive findings in smaller stents (<or=2.75 mm), it reliably rules out in-stent restenosis irrespective of stent size.
Pugliese
F
F
Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands. francesca.pugliese@libero.it
Weustink
A C
AC
Van Mieghem
C
C
Alberghina
F
F
Otsuka
M
M
Meijboom
W B
WB
van Pelt
N
N
Mollet
N R
NR
Cademartiri
F
F
Krestin
G P
GP
Hunink
M G M
MG
de Feyter
P J
PJ
D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging; D017023:Coronary Angiography / Q000379:methods; D023903:Coronary Restenosis / Q000000981:diagnostic imaging*; D004812:Epidemiologic Methods; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging*; D006339:Heart Rate; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D015607:Stents; D014057:Tomography, X-Ray Computed / Q000379:methods