Coronary artery visualization using a 64-row multi-slice computed tomography in unselected patients with definite or suspected coronary artery disease: a comparison with invasive coronary angiography.
BACKGROUND
Multi-slice computed tomography (MSCT) is becoming an increasingly acknowledged means of visualizing coronary arteries. The accuracy of 64-MSCT is still a subject of clinical evaluation. Our study, performed with a 64-slice scanner, was intended to assess the concordance of coronary artery lumen visualization in MSCT and invasive coronary angiography (ICA), both in post-revascularization and previously medically treated patients.


METHODS
We examined data from 73 patients (31 women, 42 men, mean age 59 years) referred to our hospital in 2006 and 2007 who underwent MSCT and subsequent ICA. Twenty two patients had a history of previous revascularization. Of the remaining 51 patients with intermediate coronary artery disease probability, the indication for 64-MSCT was suspicion of coronary artery disease. MSCT coronary angiography was performed with Aquilion 64 scanner (Toshiba, Japan). We evaluated 15 segments of four native coronary arteries (RCA, LM, LAD and Cx in all patients plus 11 arterial and 22 venous conduits). The cut-off value for significant stenosis was the lumen cross section area reduction exceeding 50%, regardless of segment.


RESULTS
Regarding native arteries, MSCT and ICA findings were coherent in 80.8% of all patients, 93.8% of vessels, and 98.4% of segments. MSCT coronary stent patency evaluation was 90.9% correct. The by-pass grafts evaluation was entirely concordant in both methods. The respiratory and heart rate variability artifacts hindered the MSCT analysis in ten patients (13.7%). The artifacts occurrence in misinterpreted studies was nearly two-fold higher than in those that were coherent (21.4% vs. 11.9%).


CONCLUSIONS
We concluded that a reliable evaluation of the coronaries by means of 64-MSCT is feasible both in patients with suspected coronary artery disease and those with definite coronary artery disease who had previous coronary intervention. Patient selection and co-operation is necessary to avoid respiratory and heart rate variability artifacts that may hinder analysis.
Sosnowski
Maciej
M
Unit of the Noninvasive Cardiovascular Diagnostics, Medical University of Silesia, Upper Silesian Heart Centre, Katowice, Poland. maciej.sosnowski@gmail.com
Pysz
Piotr
P
Gola
Artur
A
Szymański
Leszek
L
Tendera
Michał
M
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D016477:Artifacts; D017023:Coronary Angiography / Q000379:methods*; D001026:Coronary Artery Bypass / Q000009:adverse effects; D023903:Coronary Restenosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D005240:Feasibility Studies; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted; D015203:Reproducibility of Results; D015656:Respiratory Mechanics; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome