Coronary in-stent restenosis: predisposing clinical and stent-related factors, diagnostic performance and analyses of inaccuracies in 320-row computed tomography angiography.
The aim of this study was to identify predisposing factors for coronary in-stent restenosis (ISR) and assess its detection by 320-row computed tomography angiography (CTA) using invasive coronary angiography (ICA) as a gold standard. A total of 189 patients (aged 35-79, mean age 56.6, 169 males) with 318 stents underwent ICA within 4 days after CTA. ISR was found in 19 (10.0 %) patients and 25 (7.9 %) stents. At the patient level, the presence of ISR was significantly related to the number of deployed stents (P = 0.026) and body mass index (P = 0.030). At the stent level, stents with diameter <3 mm were more likely to have ISR than those with diameter ≥3 mm (53.8 % vs. 28.9 %, P = 0.016). Bare metal stents were significantly more likely to have ISR than drug-eluting stents (15.2 % vs. 6 %, P = 0.022). ISR was not significantly related to stent length (P = 0.097) and stent placement in coronary arteries at the vessel level (P = 0.059). False-positive or false-negative results of CTA were not related to stent location, diameter, length, and strut thickness (P > 0.05). At the patient level, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CTA for detecting ISR were 90, 96, 74, 99, and 96 %, respectively. At the stent level, the corresponding figures were 92, 96, 67, 99, and 96 %. The high negative predictive value of 99 % suggests that 320-row CTA is helpful for excluding ISR.
Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Institute for Radiological Research, College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan, Republic of China. ylw0518@cgmh.org.tw.
Yung-Liang
YL
Wan
Department of Public Health and Center of Biostatistics, College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan, Republic of China.
Pei-Kwei
PK
Tsay
Department of Cardiology, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan, Republic of China.
Chun-Chi
CC
Chen
Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Institute for Radiological Research, College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan, Republic of China.
Yu-Hsiang
YH
Juan
Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Institute for Radiological Research, College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan, Republic of China.
Yu-Chieh
YC
Huang
Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Institute for Radiological Research, College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan, Republic of China.
Wen-Hui
WH
Chan
Department of Cardiology, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan, Republic of China.
Ming-Shien
MS
Wen
Department of Cardiology, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan, Republic of China. hsiehic@gmail.com.
I-Chang
IC
Hsieh
D000328:Adult; D000368:Aged; D002681:China; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging* / Q000209:etiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D054855:Drug-Eluting Stents; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000295:instrumentation*; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D015203:Reproducibility of Results; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
D008670:Metals
Computed tomography angiography; Coronary artery disease; Diagnostic accuracy; In-stent restenosis; Predisposing factors