title: High diagnostic accuracy of prospective ECG-gating 64-slice computed tomography coronary angiography for the detection of in-stent restenosis: in-stent restenosis assessment by low-dose MDCT.
abstract: OBJECTIVE
  The accuracy of computed tomography (CT) for assessment of coronary stents is as yet unproven and radiation exposure has been a concern. The aim of our study is to compare radiation dose and diagnostic performance of CT with prospective ECG-triggering versus retrospective ECG-triggering for the detection of in-stent restenosis (ISR).
  
  
  METHODS
  We enrolled 168 consecutive patients with suspected ISR, 83 studied using CT with prospective ECG-triggering (group 1) and 85 using retrospective ECG-triggering (group 2).
  
  
  RESULTS
  Prevalence of ISR according to catheter angiography was 24% in both groups. The overall evaluability was similar (93% in group 1 vs 95% in group 2). Artefact sub-analysis showed a significantly lower number of blooming and higher number of slice misalignment in group 1 vs group 2. In the stent-based analysis using only evaluable stents, specificity, positive predictive value and accuracy were significantly higher in group 1 (100%, 100% and 99%, respectively) than in group 2 (97%, 91% and 95%, respectively, p < 0.05). Group 1 was exposed to a lower radiation dose compared with group 2 (4.3 ± 1.4 mSv vs 18.5 ± 5.5 mSv, p < 00.1).
  
  
  CONCLUSIONS
  CT with prospective ECG-triggering can improve diagnostic accuracy of non-invasive imaging of coronary stents with a significant reduction in radiation exposure.
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy. daniele.andreini@ccfm.it
authors.forename: Daniele
authors.initials: D
authors.lastname: Andreini
authors.forename: Gianluca
authors.initials: G
authors.lastname: Pontone
authors.forename: Antonio L
authors.initials: AL
authors.lastname: Bartorelli
authors.forename: Saima
authors.initials: S
authors.lastname: Mushtaq
authors.forename: Daniela
authors.initials: D
authors.lastname: Trabattoni
authors.forename: Erika
authors.initials: E
authors.lastname: Bertella
authors.forename: Sarah
authors.initials: S
authors.lastname: Cortinovis
authors.forename: Andrea
authors.initials: A
authors.lastname: Annoni
authors.forename: Alberto
authors.initials: A
authors.lastname: Formenti
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ballerini
authors.forename: Piergiuseppe
authors.initials: P
authors.lastname: Agostoni
authors.forename: Cesare
authors.initials: C
authors.lastname: Fiorentini
authors.forename: Mauro
authors.initials: M
authors.lastname: Pepi
mesh_terms: D016009:Chi-Square Distribution; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging*; D004562:Electrocardiography; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging*; D006801:Humans; D007479:Iopamidol / Q000031:analogs & derivatives; D016014:Linear Models; D008297:Male; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D011829:Radiation Dosage; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015607:Stents; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol