冠状动脉造影检查在冠心病诊断中作用的再探讨

目的探讨冠状动脉造影（CAG）检查在诊断冠心病中作用,就其对多年来被认为是金标准作用进行再探讨。方法对138例怀疑有冠心病的患者,均经普通ECG,动态ECG,活动平板和CAG。结果只有71例患者的冠状动脉造影检查符合目前冠心病标准,其余67例患者冠状动脉未达标（轻度-中度狭窄,或完全正常或仅见散在斑块形成）。结论冠心病的诊断是一个较为复杂的问题,CAG检查是诊断冠心病的一个重要依据,有相当比例的冠心病患者（CAG）无明显异常。     

An analysis of patients receiving emergency CAG without PCI and the value of GRACE score in predicting PCI possibilities in NSTE-ACS patients

Background There are patients who underwent emergency coronary angiography (CAG) but did not receive percutaneous coronary intervention (PCI). The aim of this study was to analyze these reasons. Methods This is a single-center retrospective study. We recruited 201 consecutive patients who received emergency CAG but did not receive PCI. To investigate the value of the Global Registry of Acute Coronary Events (GRACE) score in predicting PCI possibilities in non-ST segment elevation acute coronary syndrome (NSTE-ACS) patients, we recruited 80 consecutive patients who presented with NSTE-ACS and received emergency CAG as well as emergency PCI. Results Among the 201 patients who received emergency CAG but did not receive PCI, 26% patients had final diagnosis other than coronary heart disease. In the patients with significant coronary artery stenosis, 23 patients (11.5%) were recommended to coronary artery bypass grafting (CABG), one patient (0.5%) refused PCI; 13 patients (6.5%) with significant thrombus burden were treated with glycoprotein IIb/IIIa receptor antagonist; 74 patients (36.8%) were treated with drug therapy because no severe stenosis (> 70%) was present in the crime vessel. Moreover, 80 of the 201 patients were presented with NSTE-ACS (excluding those patients with final diagnosis other than coronary heart disease, excluding those patients planned for CABG treatment), referred as non PCI NSTE-ACS. When comparing their GRACE scores with 80 consecutive patients presented with NSTE-ACS who received emergency CAG as well as emergency PCI (referred as PCI NSTE-ACS), we found that PCI NSTE-ACS patients had significantly higher GRACE scores compared with non PCI NSTE-ACS patients. We then used Receiver Operator Characteristic Curve (ROC) to test whether the GRACE score is good at evaluating the possibilities of PCI in NSTE-ACS patients. The area under the curve was 0.854 ± 0.030 (P < 0.001), indicating good predictive value. Furthermore, we analyzed results derived from ROC statistics, and found that a GRACE score of 125.5, as a cut-off, has high sensitivity and specificity in evaluating PCI possibilities in NSTE-ACS patients. Conclusions Our findings indicate that the GRACE score has predictive value in determining whether NSTE-ACS patients would receive PCI.     

孤立性左冠状动脉主干狭窄的诊治分析

目的分析孤立性左冠状动脉主干(左主干)狭窄的临床特点、造影所见和治疗方法.方法根据冠状动脉造影病变特点将129例左主干狭窄患者分为两组:孤立性左主干狭窄组7例;左主干合并一支或以上主要冠状动脉支狭窄组122例,对比分析两组间临床特点、造影所见和治疗方法.结果孤立性左冠状动脉主干狭窄的检出率为0.16%.6例表现为不稳定型心绞痛,1例为急性前壁心肌梗死.左主干狭窄部位:开口部4例,中部2例,叉口部1例.4例行外科手术,3例行冠状动脉支架术.与复合病变组相比较,孤立性左主干狭窄组女性的比例较高(57.1%vs20.5%,P<0.05),平均年龄较小[(52.3±5.1)岁vs(64.2±7.8)岁,P<0.001];开口部狭窄多见(57.1%vs17.2%,P<0.05).结论孤立性左冠状动脉主干狭窄以女性多见,以开口部狭窄多见,可选择外科和介入治疗.     

64排螺旋CT冠状动脉成像在无保护左主干冠脉病变PCI中的应用价值

目的 探讨64排螺旋CT冠状动脉成像（CTA）在冠状动脉无保护左主干病变（UPLM）介入治疗中的应用价值.方法 随机选取25例2012年1月至2014年1月在粤北人民医院心血管内科临床诊断为冠心病,并进行经导管冠脉造影（CAG）,确诊为UPLM的患者.其中12例患者术前进行了CTA检查;13例患者术前未进行CTA检查,而直接进行CAG及PCI.结果 12例介入诊疗前进行CTA检查的患者,CTA检查阳性预测值为100％,介入治疗均成功,手术成功率100％,术中未出现低血压及慢血流等并发症情况,PCI平均操作时间（30±5）min.13例术前未进行CTA检查的患者,有11例选择行PCI并成功,PCI成功率100％.但其中有6例患者在CAG及PCI术中出现低血压（46％）,2例患者术中出现冠脉慢血流（15％）,整体并发症发生率为61％,与CTA组比较差异有统计学意义（P＜0.01）;PCI平均操作时间（50±9）min,较CTA组明显增加（P＜0.01）.另外2例患者术前未行CTA检查,行CAG后放弃PCI治疗,择期行CABG（15％）.结论 冠心病患者术前行CTA检查,有助于提前发现UPLM,从而提高UPLM患者介入手术成功率,减少术中并发症.     

64层螺旋CT与冠状动脉造影诊断冠状动脉狭窄的对比研究

目的评价64层螺旋CT冠状动脉成像(64-slice spiral computed tomographic coronary angiography,64-SCTCA)对冠状动脉各节段狭窄病变的诊断价值。方法85例疑诊为冠状动脉性心脏病(冠心病)患者,先后行64-SCTCA和冠状动脉造影(coronary angiography,CAG)检查,评价64-SCTCA诊断冠状动脉各节段狭窄病变的敏感性、特异性、阳性预测值、阴性预测值和准确性。结果①在CAG可清晰显影的744个节段中,64-SCTCA造影可清晰显示和评价的占639段(85.89%),另外105段(14.11%)显影不清。左主干和前降支可评价节段的比例显著高于左回旋支和右冠状动脉(P0.001),同一支血管中近段可评价的比例显著高于远段(P0.001);②64-SCTCA诊断冠心病的敏感度、特异度、准确度、阳性和阴性预测值分别为96.23%、90.63%、94.44%、93.55%、94.12%。按可评价节段计算,64-SCTCA诊断冠状动脉各节段有意义狭窄病变总的敏感性、特异性、准确性、阳性和阴性预测值分别为89.06%、95.89%、84.44%、95.33%、94.32%;③按可评价节段计算,64-SCTCA对诊断左主干、左前降支、左回旋支和右冠状动脉各节段病变的价值相似,但检测冠状动脉近中段病变的价值高于远段(χ2=4.66,P=0.03)。结论64-SCTCA对冠状动脉狭窄病变有较好的诊断价值,其检测左主干和左前降支病变的价值高于左回旋支和右冠状动脉,对冠状动脉近段病变的诊断价值高于远段,适合于冠心病的筛查。     

冠心病介入治疗中应用低分子肝素与普通肝素的随机对照研究

目的探讨冠心病患者经皮冠状动脉介入治疗（PCI）中应用低分子肝素（LMWH）替代普通肝素（UFH）的安全性和有效性。方法自2003年10月至2005年2月共入选966例申请一次性行PCI的患者,所有患者均签署了知情同意书。966例患者中最终完成PCI治疗者455例[包括283例为非ST段抬高急性冠脉综合征（ACS）者]。未接受PCI治疗者511例。研究采用随机对照方法,将入选患者分为LMWH组和静脉UFH组,LMWH组484例,静脉UFH组482例。LMWH组采用依诺肝素（enoxaparin）,按1mg／kg的剂量于PCI手术前至少给予2次皮下注射（每12h一次）,PCI手术在最后1次皮下注射30min后开始。完成冠状动脉造影或PCI后,立即拔出鞘管。静脉UFH组的患者于手术前即刻先给予普通肝素25rIlg静脉推注,如果造影显示适合PCI时,再追加65mg。完成PCI后4h左右拔出鞘管。LMWH组和静脉UFH组中最终行PCI者各为227例和228例。结果（1）LMWH组中1例于PCI术中发生急性血栓形成致急性心肌梗死（AMI）,PCI术后及住院期间未见急性和亚急性血栓形成。静脉UFH组术中和住院期间无急性和亚急性血栓形成。住院期间心脏事件发生率（死亡、AMI和再次血管重建）在LMWH组为0．44％,静脉UFH组为0;（2）LMWH组均于术后即刻拔出鞘管,穿刺局部发生血肿8例,静脉UFH组于术后4h左右拔出鞘管,穿刺局部发生血肿20例,前者血肿发生率明显低于后者,差异有统计学意义（P〈0．05）;（3）随访1个月LMWH组心脏事件发生率为0,静脉UFH组1例于院外发生亚急性血栓致AMI,再次行PCI成功,随访期间心脏事件发生率为0．43％。结论本研究结果提示对于拟行PCI的冠心病患者或非sT段抬高ACS患者术前给予至少2次依诺肝素皮下注射（1mg／kg,每12h一次）,并于最后1次皮下注射的8h内行PCI是安全和有效的,术前和术中不需要给予静脉UFH,术后可即刻拔出鞘管。     

冠状动脉旁路移植术和药物支架植入术远期疗效的比较

目的比较冠心病患者非药物治疗手段冠状动脉旁路移植术（CABG）和经皮冠状动脉介入治疗（PCI）术后的桥血管和支架的再通率。方法CABG术后和药物支架植入术后再次出现心绞痛症状的冠心病患者各40例,其年龄、性别、心肌梗死、高血压、高脂血症、心功能不全、脑卒中、药物治疗病史具有可比性。通过冠状动脉造影术比较两组患者的桥血管和药物支架的效率和寿命的远期效果。结果与行CABG患者的桥血管比较,行PCI患者的药物支架远期狭窄或者闭塞率降低34．3％。与行CABG患者的左乳内动脉（LIMA）桥血管比较,行PCI患者的左前降支的药物支架远期狭窄或者闭塞率降低14．8％。与行CABG患者的左回旋支和右冠状动脉静脉桥血管比较,行PCI患者的左回旋支以及右冠状动脉的药物支架远期狭窄或者闭塞率降低49．8％。结论冠状动脉药物支架植入术的远期通畅率较CABG明显增高,冠状动脉药物支架植入术的药物支架的效率和寿命要优于CABG的桥血管。     

64排螺旋CT评价冠状动脉旁路移植术后桥血管的效果

目的：探讨64排螺旋CT在冠状动脉桥血管的临床应用价值。方法：对42例冠状动脉旁路术后病人,共145条桥血管（其中内乳动脉46条,大隐静脉桥99条）,进行64排螺旋CT造影（CTA）。CT扫描时病人的平均心室率为（60±5）次／min。42例中20例桥血管血管吻合口冠状动脉狭窄（≥50％）或闭塞的病人及7例吻合口远端狭窄或闭塞的病人同时进行了冠状动脉造影（CAG）。结果：42例病人CTA均可评价。显示桥血管通畅125条．闭塞20条（其中内乳动脉5条,静脉桥15条）。CTA诊断冠状动脉桥血管狭窄（≥50％）或闭塞的准确性达100％。结论：CTA可以准确评价冠状动脉桥血管以及吻合口再狭窄的程度,桥血管近端吻合口的位置,可提示冠状动脉桥血管术后CAG的径路,是评价冠状动脉桥血管病变．创伤性小的首选方法。     

2型糖尿病合并冠心病患者行双源CT冠状动脉造影的对比研究

目的探讨双源CT冠状动脉造影在2型糖尿病合并冠心病患者诊断中的应用价值。方法选择临床确诊或疑诊冠心病的2型糖尿病患者88例行CT冠状动脉造影检查,并同期行选择性冠状动脉造影。双源CT的原始数据均行容积再现、曲面重组、最大密度投影及横断面重建。结果 352支血管中(直径≥2 mm),双源CT冠状动脉造影显示≥50%狭窄的血管为163支,占46.3%;选择性冠状动脉造影显示≥50%狭窄的血管为155支,占44.0%。与选择性冠状动脉造影对照分析,双源CT冠状动脉造影评价冠状动脉狭窄(≥50%狭窄)的敏感性、特异性、阳性预测值以及阴性预测值分别为92.3%、89.9%、87.7%和93.7%。结论双源CT冠状动脉造影是检测2型糖尿病患者冠状动脉狭窄的可靠方法。     

定量多层螺旋CT冠状动脉成像与定量冠状动脉造影的对比研究

目的通过与同期定量冠状动脉造影(QCA)作对照,评价定量冠状动脉多层螺旋CT(QCT)成像对冠状动脉疾病的诊断价值。方法选择冠心病患者78例,利用QCA和QCT测量同一病变的最小管腔直径、最小管腔面积、参考直径、参考面积、靶病变长度、直径狭窄率、面积狭窄率等指标,比较2种方法结果的相关性及一致性。结果 78例患者中,存在明显冠状动脉病变62例(79.49%),QCT和QCA一致认为重度狭窄(>75%)的节段共为47段,其中右冠状动脉1 5段,前降支27段,回旋支5段。QCT和QCA测量的最小管腔面积、面积狭窄率比较,差异有统计学意义(P<0.05),2种测量最小管腔直径、参考直径、参考面积、靶病变长度和直径狭窄率的比较,差并均无统计学意义(P>0.05)。QCT和QCA测量最小管腔直径,靶病变长度,参考直径,参考面积,直径狭窄率一致性较好(0.5≤r_c≤0.85),最小管腔面积、面积狭窄率则一致性不佳(r_c<0.5)。结论 QCT检查能良好评价冠状动脉病变.可用于术前即可指导对经皮冠状动脉介入治疗中球囊和支架的选择。     

64层螺旋CT对老年冠状动脉疾病患者的诊断价值评价

目的探讨64层螺旋CT对老年冠状动脉疾病患者的诊断价值。方法对61例疑为冠心病的老年患者进行冠状动脉64层螺旋CT扫描,并于1周之内进行冠状动脉造影检查。以冠状动脉造影为“金标准”,评价冠状动脉64层螺旋CT诊断老年冠状动脉疾病患者的敏感性、特异性、阳性预测值、阴性预测值及准确度。结果61例患者总计915个冠状动脉节段,64层螺旋CT能够评价其中882个节段(96．4％),其检测中度以上冠状动脉狭窄的敏感性75．6％,特异性88．1％,阳性预测值64．0％,阴性预测值92．8％,准确度85．4％。结论64层螺旋CT对老年冠状动脉疾病患者具有较高的诊断价值,有可能成为筛查老年人冠心病的一个较为可靠的无创检测手段     

CT冠状动脉成像在诊断心肌桥及壁冠状动脉中的价值

目的探讨64排螺旋CT（64SCT）冠状动脉成像在诊断心肌桥及壁冠状动脉的应用价值。方法回顾性分析64SCT冠状动脉成像患者230例,统计心肌桥的检出率、部位、厚度、壁冠状动脉狭窄程度,分析其与临床症状的关系。结果在230例进行64SCT冠状动脉成像患者中,发现心肌桥53例（共60处）,检出率为23．04％（53／230）,与CAG的检出率（5．2％）比较差异有统计学意义（P〈0．05）,64SCT中仅有13支与CAG发现的14支心肌桥一致。浅表型肌桥和深在型肌桥在厚度、壁冠状动脉狭窄程度及临床症状均有统计学差异（P〈0．05）。结论64SCT冠状动脉成像是一种无创、较为准确诊断心肌桥的手段。     

Valsartan cardio-renal protection in patients undergoing coronary angiography complicated with chronic renal insufficiency (VAL-CARP) trial: rationale and design.

BACKGROUND: Despite an increase in the frequency of coronary angiography (CAG) in Japan, the exact incidence of contrast-induced nephropathy (CIN) remains unknown in the Japanese population, especially in patients with chronic renal insufficiency. In addition, the nature of pharmacological interventions that would benefit the patients before or after procedures such as coronary bypass graft (CABG) and percutaneous coronary intervention (PCI) has not been fully investigated. METHODS: In the trial 500 patients with renal insufficiency (defined as a glomerular filtration rate (GFR) of between 89 and 30 ml . min(-1) . (1.73 m(-2)) following CAG will be randomly assigned to receive either valsartan, an angiotensin receptor blocker or angiotensin converting enzyme (ACE) inhibitor plus valsartan.1 The primary end-point is a change in the GFR of patients, which will be followed up for 3 years, including following CABG surgery or PCI. The incidence of cardiac events as well as the adverse effects of pharmacological intervention will be evaluated. In addition, the incidence of renal artery stenosis at the time of CAG will be reported also; however, the patients with renal artery stenosis will be excluded from the present study. CONCLUSION: The present study will provide data on: 1) the exact incidence and course of renal function of CIN after CAG; and 2) the comparative therapeutic benefit of pharmacological intervention with valsartan alone or with valsartan and an ACE inhibitor in combination in patients with coexisting coronary artery diseases and chronic renal insufficiency, regardless of whether they receive CABG or PCI. In addition to these studies, an estimate of the incidence of renal artery stenosis in these patients will be demonstrated.     

光学相干断层成像在老年冠心病介入诊疗中的初步应用

目的探讨血管内光学相干断层成像（OCT）在老年冠心病介入诊疗中的作用和安全性，评价其临床价值。方法9例老年冠心病患者，行冠脉造影和OCT检查，比较二者对冠状动脉病变的显示情况：包括病变结构、管腔狭窄程度、斑块性质等，根据造影及OCT结果参照病人临床表现对于狭窄较重（造影直径狭窄率〉70％），或造影中等程度狭窄（直径狭窄率介于50％～70％），但OCT狭窄相对较重（OCT管腔面积狭窄率〉60％）并伴有不稳定斑块的病变进行球囊扩张和支架植入治疗，并用OCT评价支架植入后的即时效果。结果与冠脉造影相比，血管内OCT能直观、清晰、实时地显示病变冠脉的管腔狭窄程度、微观组织结构、斑块组成性质及支架植入后靶病变血管及支架的形态特征。结论OCT在老年冠心病患者中的操作安全易行，能够精确测量病变血管狭窄程度、清晰观测管腔微观结构特征，明确斑块特征，指导支架植入及观测支架植入后的即刻效果，对老年冠心病人介入治疗具有指导作用。     

The role of elective coronary surgery early after acute myocardial infarction in the era of primary percutaneous coronary intervention

AIMS: There is a group of patients with acute myocardial infarction (AMI), who, according to results of emergency coronary angiography and regardless of performed or not performed primary percutaneous coronary intervention (PCI), are qualified for elective coronary artery bypass grafting (CABG).The authors have not found a publication that focuses on this problem.They tried to determine the base-line characteristic of this subgroup as well as appreciate its operative surgical risk. METHODS AND RESULTS: Emergency coronary angiography - followed by primary PCI when appropriate - was performed in 1867 consecutive patients with AMI. Of all these patients, 85 (4.6%) were qualified at the further stage of treatment for elective CABG. Compared with patients requiring only PCI (n = 1771), those undergoing elective CABG were the same age (61.9 +/- 9.4 vs. 61.8 +/- 12.8 years) and gender, but more frequently suffered from hypertension, diabetes mellitus, lipid disorders and multi-vessel disease. The majority of CABG patients (56.5%) belonged to the medium risk group according to the calculated EuroSCORE ratio.The mean value of the logistic EuroSCORE was 5.26 +/- 8.07. CONCLUSIONS: The elective CABG in patients early after AMI, who underwent emergency coronary angiography to perform primary PCI, is an integral part of treatment. However, this procedure usually regards only few patients. Numerous risk factors of coronary artery disease are present in those patients, who belong, however, to the medium operative risk group.     

64层CT冠状动脉成像技术和冠状动脉造影对冠状动脉疾病诊断的对照研究

目的比较64层计算机断层摄影扫描冠状动脉成像技术(64-slice computed tomography coronaryangiography,64-SCTCA)和冠状动脉造影(coronary artery angiography,CAG)在冠状动脉粥样硬化性心脏病(冠心病)诊断中的价值。方法回顾性分析126例疑似冠心病的患者64-SCTCA和CAG检查资料,并对两组资料进行对比分析。结果 64-SCTCA和CAG检查结果中可用于评价的病变血管段支数比较,差异无统计学意义(P0.05)。CAG共发现≥50%狭窄节段242个,64-SCTCA共发现≥50%狭窄节段199个,两种检查方法对病变狭窄的显示情况比较,差异无统计学意义(P0.05)。全部126例冠心病患者中有91%通过64-SCTCA发现(110/121)。64-SCTCA诊断冠状动脉病变血管的敏感性、特异性、阳性预测值、阴性预测值分别为81.6%、98.8%、79.5%、99%。结论 64-SCTCA可作为冠心病无创、便捷、可靠的检查方法。     

Changes in patterns of coronary revascularization strategies for patients with acute coronary syndromes (from the CRUSADE Quality Improvement Initiative)

Since the introduction of drug-eluting stents (DESs), patterns of revascularization strategies for patients with non-ST-segment elevation acute coronary syndromes have not been assessed. We studied 82,924 patients from the CRUSADE Initiative who presented with non-ST-segment elevation acute coronary syndromes and underwent coronary angiography at 365 United States hospitals that had capabilities for surgical (coronary artery bypass grafting [CABG]) and percutaneous (percutaneous coronary intervention [PCI]) revascularization from January 2002 to June 2005. Temporal trends in the use of PCI, CABG, and medical management without revascularization were analyzed with respect to the introduction of DESs. In total, 73,577 patients (89%) had >50% stenosis in > or =1 coronary artery, and there was a significant increase in the use of PCI (vs CABG or medical management without revascularization) during the study period (38.3% vs 52.5%). By quarter 2 of 2005, 80% of patients who underwent PCI received a DES. In total, 18,462 of 25,068 patients (73.6%) with 3-vessel disease (3VD) underwent revascularization and use of CABG decreased for these patients (48.9% to 39.9%, p <0.001), whereas use of PCI increased (51.1% to 60.1%, p <0.001). Factors significantly associated with use of PCI for patients with 3VD who underwent any revascularization included previous PCI, previous CABG, cardiology inpatient care, care at an academic hospital, renal insufficiency, and previous congestive heart failure. In conclusion, coinciding with the introduction of DESs, there has been a significant increase in the use of PCI and, in those patients with 3VD, a decrease in the use of CABG with a shift toward increasing use of PCI. Long-term implications of this shift remain uncertain, especially in patients with 3VD.     

药物洗脱支架在冠心病无保护左主干病变中的应用

目的评价药物洗脱支架治疗经选择冠心病无保护左主干病变的安全性和有效性。方法2003年1月~2005年6月间,共有48例经选择的冠心病患者,年龄39~81岁,经冠状动脉造影证实为无保护左主干病变(左主干狭窄均≥75%)行介入治疗置入药物洗脱支架。结果48例患者介入治疗均获得成功,共置入药物洗脱支架75枚(51 Cypher,18 Taxus,6 Firebird)。其中左主干开口部狭窄5例(10.4%,5/48),体部狭窄6例(12.5%,6/48),远端分叉部位狭窄37例(77.1%,37/48)。37例远端分叉部位狭窄患者中,主支支架加边支经皮冠状动脉介入治疗(PCI)10例,双支架术27例,最后成功对吻球囊扩张30例(81.1%,30/37)。所有患者治疗后临床症状明显缓解或消失,住院及6个月随访期间无严重心血管事件发生,43例患者术后6个月行冠状动脉造影随访,2例患者再狭窄(均为分叉病变)行冠状动脉旁路移植术(CABG),冠状动脉造影随访率89.6%,再狭窄率4.7%。结论药物洗脱支架介入治疗冠心病无保护左主干病变安全有效,近中期效果良好。     

冠状动脉双源CT与冠状动脉造影成像对急诊胸痛患者诊断冠心病的价值

目的:以常规冠状动脉造影(CAG)为"金标准",探讨急诊胸痛患者双源CT(DSCT)冠状动脉血管成像诊断冠心病的价值,分析DSCT诊断冠心病的准确度、灵敏度、特异度、阳性预测值和阴性预测值。方法:对115例以胸痛为主诉的急诊就诊、临床怀疑冠心病拟行CAG的患者[男60例,女55例,平均年龄(66.37±10.29)岁]进行DSCT冠状动脉成像,统计分析DSCT对诊断冠状动脉不同程度狭窄冠心病的准确度、灵敏度及特异度,并与CAG结果对比。结果:共获得92例有诊断价值的病例,DSCT诊断冠状动脉中重度狭窄的准确度为94.6%,灵敏度、特异度、阳性预测值和阴性预测值分别为96.7%、90.6%、95.1%和93.5%。对于诊断轻度狭窄冠心病的灵敏度为70.6%,特异度为63.9%,阳性预测值为34.3%,阴性预测值为91.2%。结论:DSCT冠状动脉成像可作为临床冠心病可疑患者CAG手术前的预筛手段,当患者的冠状动脉为中重度狭窄时,诊断的准确度、灵敏度、特异度较高,DSCT与CAG有很好的一致性,其对是否需进一步CAG检查有较大的指导意义。DSCT对于冠状动脉轻度狭窄患者的阴性预测值较高,提示如果DSCT判定患者无冠状动脉病变,基本上无进一步行CAG的必要。     

64层螺旋CT对冠心病患者再血管化治疗后的疗效评价

目的探讨64层螺旋CT追踪观察冠心病患者冠状动脉再血管化治疗后冠状动脉再狭窄的发生和心功能的变化。方法对28例冠状动脉旁路移植术患者和114例支架植入术患者进行64层螺旋CT冠状动脉造影和左心功能分析;观察吻合口的形态和桥血管/支架再狭窄的发生,计算左心功能指标,用以评价并比较二种冠状动脉再血管化治疗方法的疗效。结果冠心病患者在接受冠状动脉旁路移植术和支架植入术后左心室射血分数和每搏输出量明显增高;1年以后支架植入术后再狭窄发生率高于冠状动脉旁路移植术后;冠状动脉旁路移植术后3年以上者左心室射血分数和每搏输出量明显高于支架植入术后。结论64层螺旋CT心脏检查在冠心病患者再血管化治疗后疗效评价和随访中具有重要意义。