Elsevier

International Journal of Cardiology

Volume 274, 1 January 2019, Pages 382-387
International Journal of Cardiology

Diagnostic accuracy of coronary CT angiography performed in 100 consecutive patients with coronary stents using a whole-organ high-definition CT scanner

https://doi.org/10.1016/j.ijcard.2018.09.010Get rights and content

Highlights

  • This study is the first to evaluate the CCTA capability of detecting ISR in a cohort of patients, including those with high HR and AF

  • With a whole-organ CT scanner high quality images of coronary stents can be obtained, allowing good interpretability and diagnostic accuracy

Abstract

Aims

To evaluate image quality, interpretability, diagnostic accuracy and radiation exposure of coronary CT angiography (CCTA) performed with a new scanner equipped with 0.23-mm spatial resolution, new generation iterative reconstruction, 0.28-second gantry rotation time and intra-cycle motion-correction algorithm in consecutive patients with coronary stents, including those with high heart rate (HR) and atrial fibrillation (AF).

Materials and methods

We enrolled 100 consecutive patients (85 males, mean age 65 ± 10 years) with previous coronary stent implantation scheduled for clinically indicated non-emergent invasive coronary angiography (ICA). Image quality, coronary interpretability and diagnostic accuracy vs. ICA were evaluated and the effective dose (ED) was recorded.

Results

Mean HR during the scan was 67 ± 13 bpm. Twenty-six patients had >65 bpm HR during scanning and 13 patients had AF. Overall, image quality was high (Likert = 3.2 ± 0.9). Stent interpretability was 95.8% (184/192 stents). Among 192 stented segments, CCTA correctly identified 22 out of 24 with >50% in-stent restenosis (ISR) (sensitivity 92%). In a stent-based analysis, specificity, positive and negative predictive values and diagnostic accuracy for ISR detection were 91%, 99%, 60% and 91%, respectively. In a patient-based analysis, CCTA diagnostic accuracy was 85%. Overall, mean ED of CCTA was 2.4 ± 1.2 mSv.

Conclusions

A whole-organ CT scanner was able to evaluate coronary stents with good diagnostic performance and low radiation exposure, also in presence of unfavorable HR and heart rhythm.

Translational aspect

The present study is the first to evaluate the CCTA capability of detecting in-stent restenosis in consecutive patients, including those with high HR and AF, using a recent scanner generation that combines improved spatial and temporal resolution with wide coverage. Using the whole-organ high-definition CT scanner we obtained high quality images of coronary stents with good interpretability and diagnostic accuracy combined with low radiation exposure, even in patients with unfavorable HR or heart rhythm for CCTA evaluation.

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.

Section snippets

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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