Diagnostic accuracy of coronary CT angiography performed in 100 consecutive patients with coronary stents using a whole-organ high-definition CT scanner
Introduction
Coronary CT angiography (CCTA) has emerged as a reliable tool for the diagnosis of coronary artery disease (CAD) and the evaluation of patients who underwent percutaneous coronary intervention (PCI) [1]. Although some studies showed reasonable diagnostic performance of 64-slice CCTA for in-stent restenosis (ISR) detection [[2], [3], [4], [5], [6]], a 9–10% rate of non-assessable stents has been reported by previous meta-analyses [7,8]. Moreover, previous CCTA studies enrolled selected patients with stable and low heart rate (HR) and excluded those with irregular heart rhythm or HR > 65 beats per minute (bpm) [[9], [10], [11]]. Thus, current appropriateness criteria still consider CCTA of questionable clinical value for coronary stent evaluation [12]. Recently, a new scanner has been introduced in the clinical field. The main technological innovations are improved spatial resolution (0.23-mm), a new-generation iterative reconstruction, faster gantry rotation time and an intra-cycle motion-correction algorithm enhancing temporal resolution [13]. Aim of the present study was to assess image quality and interpretability, diagnostic accuracy and radiation exposure of the new scanner in consecutive patients previously treated with coronary stents. They were enrolled irrespective of HR or presence of atrial fibrillation (AF), using invasive coronary angiography (ICA) as a reference standard.
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Study population
We prospectively assessed for enrollment 103 consecutive patients (85 men, mean age 65 ± 10 years). All patients were previously treated with coronary stent implantation and were scheduled for ICA between March 2015 and February 2016 because of anginal symptoms (n = 48, 47%) or positive stress test (n = 55, 53%). The mean time from index PCI to CCTA was 12 ± 7 months. Exclusion criteria were contraindications to contrast agent administration and impaired renal function (creatinine clearance
Baseline characteristics
Table 1 shows the clinical and procedural characteristics of the study population. We excluded three patients because of impaired renal function. Among 100 enrolled patients, 61 were in sinus rhythm with HR ≤65 bpm, whereas 26 were in sinus rhythm with HR >65 bpm and 13 had AF.
CT evaluability and image quality
The Supplementary Table 1 shows the image quality score using the 4-point Likert scale in the entire population and in the two groups of patients. Overall image quality was high (Likert = 3.16 ± 0.9). No significant
Discussion
The present study is the first to evaluate the CCTA capability of detecting ISR in a cohort of consecutive patients, including those with high HR or AF, using a recent scanner generation that combines improved spatial and temporal resolution with wide coverage. The main finding of our study is that the novel whole-organ high-definition CT scanner provided high quality images of coronary stents, allowing good interpretability and diagnostic accuracy combined with low radiation exposure. Of note,
Conclusions
The scanner used in the present study was able to evaluate coronary stent patency with high image quality and diagnostic accuracy in patients with suspected ISR, even in those with unfavorable HR or heart rhythm. At the patient-level, the CCTA diagnostic accuracy was good but lower if compared with the stent-related findings.
Conflict of interest
The authors assure that no relationship with industry and no competing interests exist.
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