Evaluation of coronary in-stent restenosis by 64-slice computed tomography in patients with optimal heart rate control by systematic administration of beta-blocker drugs.
BACKGROUND
Imaging artifacts due to metallic stent struts can reduce the diagnostic accuracy of multislice computed tomography (MSCT) in the evaluation of in-stent restenosis (ISR). Our aim was to determine the accuracy of binary ISR exclusion using a 64-slice MSCT scanner and a systematic administration of beta-blockers having an aggressive heart rate (HR) control.


METHODS
We performed 64-slice MSCT in 218 consecutive patients revascularized by stenting. All patients were treated with oral/intravenous beta-blocker drugs in order to obtain a HR less than 65 beats/min in the prescan phase. Coronary stents were evaluated by two experienced observers in order to rule out the presence of significant (>50%) ISR. Quantitative conventional coronary angiography (CCA) served as a standard for reference.


RESULTS
Five patients (2.3%) were excluded from the analysis; mean HR was 59 +/- 3 beats/min in the prescan phase and 62 +/- 5 beats/min during acquisition. In the 321 stented coronary segments, CCA found 27 significant ISRs. MSCT correctly diagnosed 26 significant ISRs, with two false-positive and one false-negative case. In a per-segment analysis, the sensitivity was 96%, specificity 99%, positive predictive value (PPV) 92.8%, and negative predictive value (NPV) 99%. In a per-patient analysis, the sensitivity was 100%, specificity 98.9%, PPV 92.8%, and NPV 100%.


CONCLUSIONS
In our study, the evaluation of significant ISR by MSCT showed an excellent diagnostic accuracy with a PPV of 92.8% and a NPV of 99%. Selection criteria and radiation exposure can be considered a limitation of the method.
Martuscelli
Eugenio
E
Department of Internal Medicine, University of Tor Vergata, Rome, Italy. e.martuscelli@libero.it <e.martuscelli@libero.it>
Romagnoli
Andrea
A
D'eliseo
Alessia
A
Sperandio
Massimiliano
M
Di Luozzo
Marco
M
De Angelis
Barbara
B
Romeo
Francesco
F
Simonetti
Giovanni
G
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000368:Aged; D019917:Blood Vessel Prosthesis Implantation; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging*; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
D000319:Adrenergic beta-Antagonists