64层螺旋CT对稳定型心绞痛及急性冠状动脉综合征患者冠状动脉病变的诊断价值

目的:评价64层螺旋CT(multislice spiral computed tomography,MSCT)对临床表现为稳定型心绞痛以及非ST段抬高急性冠状动脉综合征患者冠状动脉病变的诊断价值.方法:回顾性分析北京大学第一医院心内科自2006年2月至2007年2月间接受了64层MSCT以及冠状动脉造影检查的患者资料.以定量冠状动脉造影(quantitative coronary angiography,QCA)结果为金标准,采用诊断试验评价方法,计算64层MSCT在患者水平、血管水平对》50%的管腔狭窄病变的敏感性、特异性、阳性预测价值、阴性预测价值、ROC曲线下面积;进一步将受检对象按照临床表现分为稳定型心绞痛及非ST段抬高急性冠状动脉综合征两组,分别评估64层MSCT对冠状动脉病变的诊断价值.结果:共120名受检对象入选到本研究中,其中临床表现为急性冠状动脉综合征55例(45.8%),稳定型心绞痛42例(35.0%),不典型胸痛23例(19.2%).在患者水平上,64层MSCT诊断冠状动脉病变的敏感性为92.5%,特异性为50%,整体准确性为87.5%, ROC曲线下面积0.71;在血管水平上,64层MSCT诊断冠状动脉病变的敏感性为69.9%,特异性为83.8%,阳性预测价值为81.1%,阴性预测价值为73.7%,ROC曲线下面积0.77;64层MSCT在临床表现为稳定型心绞痛及急性冠状动脉综合征患者中对冠状动脉病变的诊断价值相似,两组中MSCT的敏感性、特异性、阳性预测价值、阴性预测价值、ROC曲线下面积分别为70.2% vs 69.2%、76.2% vs [86.0%、]74.7% vs 85.6%、71.9% vs 69.9%、0.73 vs 0.78.结论:64层MSCT对临床表现为稳定型心绞痛以及非ST段抬高急性冠状动脉综合征患者冠状动脉病变检出的整体准确性相似,可以作为不同临床表现的冠心病患者的筛查手段.

Diagnostic performance of 64-channel multislice computed tomography in assessment of significant coronary artery disease in subjects suspected as acute coronary syndrome and stable angina

Objective:To evaluate the diagnostic accuracy of 64-channel multislice spiral computed tomography(MSCT) in subjects with presentations suggestive of stable angina or acute coronary syndrome. Methods: Subjects received both 64-channel MSCT and coronary angiography, from Feb. 2006 to Feb. 2007, were enrolled for retrospective analyses. Results of the quantitative coronary angiography were used as the "Golden criteria", accuracy of 64-channel MSCT were evaluated in the overall sample, as well as in subjects suspected of stable angina and acute coronary syndrome. Results: A total of 120 subjects were enrolled in the analyses. On the patient level, the sensitivity, specificity, and accuracy of 64-channel MSCT in detecting significant stenoses were 92.5%, 50%, and 87.5%, respectively. The overall ROC area under curve was 0.71. On the artery level, sensitivity, specificity, positive predictive value, negative predictive value, and ROC area under curve of 64-channel MSCT were 69.9%, 83.8%, 81.1%, 73.7%, and 0.77, respectively. Further analyses showed the sensitivity, specificity, positive predictive value, negative predictive value, and ROC area under curve of 64-channel MSCT in subjects presenting as stable angina and in subjects presenting as acute coronary syndrome were as follows: 70.2% vs 69.2%, 76.2% vs 86.0%, 74.7% vs 85.6%, 71.9% vs 69.9%, and 0.73 vs 0.78. Conclusion: The accuracy rates of 64-chanel MSCT in subjects presenting as stable angina and in subjects presenting as acute coronary syndrome were similar.