CCTA诊断冠状动脉支架内再狭窄的价值及再狭窄相关因素分析

目的评价冠状动脉CT血管造影(CCTA)在诊断冠状动脉支架植入术后支架内再狭窄的价值,并对再狭窄支架方面的相关因素进行分析。方法对106例冠状动脉支架植入术后患者,分别行CCTA及冠状动脉造影(CAG)检查,将CAG的诊断结果作为金标准,评估CCTA诊断支架内再狭窄的灵敏度、特异度,并分析支架内再狭窄是否与支架部位、直径、长度及类型有关。结果 (1) CCTA对106例患者的174枚支架内再狭窄的诊断特异度、灵敏度、阴性预测值、阳性预测值分别是97. 3%、91. 7%、98. 6%、84. 6%,与CAG的诊断一致性较高(Kappa=0. 860)。(2)支架内再狭窄与支架直径、狭窄性病变是否处于血管分叉处有关,与支架长度、支架所在冠脉节段、支架类型无关。结论 CCTA对冠状动脉支架内再狭窄的诊断结果与CAG的诊断结果存在较高的一致性。支架内再狭窄的形成与支架直径及狭窄性病变是否处于血管分叉处有关。     

双源CT与冠状动脉造影在冠心病患者冠状动脉支架内再狭窄评估中的价值

目的通过对比分析双源CT(DSCT)与冠状动脉造影(CAG)评估支架内再狭窄(ISR)的结果,探讨DSCT评估冠状动脉ISR的能力。方法 106例同期行DSCT冠状动脉血管成像及选择性CAG检查的患者,以CAG结果为标准,分析比较DSCT诊断ISR的敏感性、特异性及准确性。支架所在管腔狭窄大于50%被认为ISR。结果 173枚支架中,除17枚支架不能评价外,其余156枚支架DSCT全部显影良好。DSCT显示有ISR的支架33枚,CAG证实存在ISR的支架38枚,DSCT显示111枚支架内通畅,CAG证实支架内通畅118枚。DSCT诊断ISR的敏感度和特异度分别为86.8%和94.1%,阳性预测值82.5%,阴性预测值95.7%,一致率为92.3%。DSCT对直径≥3.0 mm支架的再狭窄检出的阳性预测值、特异性、敏感性优于直径<3.0 mm支架。结论 (1)DSCT可清晰显示冠状动脉支架的位置、支架腔内情况及支架远近端血管。(2)支架内径是影响支架腔内图像显示的重要原因。(3)DSCT在评估ISR方面,基本取代CAG作为大直径支架(支架直径>3 mm)通畅情况的评估方式,作为无创评估ISR的手段之一。     

窗技术及CT值测量评估冠状动脉支架狭窄的价值

目的探讨窗技术及CT值测量诊断冠状动脉支架狭窄(ISR)的临床价值。方法对21例冠状动脉支架置入的患者(共29枚)行冠状动脉造影(CAG)及CT血管造影(CTA)。采用大窗宽、窗位(2 500/900 HU),比较通畅组及狭窄组支架近端、腔内及远端CT值的差异。结果29枚支架CTA诊断通畅20枚,狭窄9枚,CAG显示通畅21枚,狭窄为8枚,两者比较,CTA诊断腔内狭窄的敏感性为100%,特异性为95.2%,阳性预测值为88.9%,阴性预测值为100%。通畅组与狭窄组支架腔内及远端的CT值有统计学差异(P<0.05);支架近端管腔的CT值无统计学差异(P=0.35)。结论 CTA是评价冠状动脉支架通畅性的有效方法,大窗宽、窗位的应用及CT值测量对PCI术后的再狭窄判断有很大的应用价值。     

双源CT评价冠状动脉支架内再狭窄的意义

目的:通过双源CT(DSCT)与选择性冠状动脉造影(CAG)对支架评估的对比分析,探讨DSCT对冠状动脉支架内再狭窄的诊断意义。方法:42例同期行双源CT冠状动脉血管成像及选择性CAG检查的患者,分析比较DSCT诊断支架内再狭窄的敏感性、特异性及准确性。结果:①DSCT按病例数诊断支架内再狭窄的敏感性86.7%、特异性96.2%、阳性预测值92.9%、阴性预测值92.6%、准确性92.7%。②DSCT按支架数诊断支架内再狭窄的敏感性76.5%、特异性95.1%、阳性预测值86.7%、阴性预测值90.7%、准确性89.7%。③DSCT与CAG比较,诊断支架内再狭窄的差异无统计学意义。④DSCT对直径≥3.0mm支架的再狭窄检出的阳性预测值、特异性、敏感性均优于直径3.0mm支架。结论:双源CT在诊断支架内再狭窄方面接近CAG,可作为支架内再狭窄的评估手段之一。     

冠状动脉CTA评估冠状动脉狭窄程度的准确性及误差分析

目的:探讨冠状动脉CT血管造影(CTA)评估冠状动脉狭窄程度的准确性及误差分析。方法:回顾性选取2019年7月—2022年6月就诊于我院心内科的病人92例,所有病人因疑诊冠心病,均先后成功接受冠状动脉CTA及冠状动脉造影(CAG)检查,并以CAG为诊断金标准,评价冠状动脉CTA筛查冠心病冠状动脉狭窄程度的准确性及误差。结果:92例病人以CAG为金标准诊断,冠状动脉CTA诊断冠心病的敏感度为89.86%,特异度为91.30%,准确度为90.22%,阳性预测值为96.88%,阴性预测值为75.00%;冠状动脉CTA评估轻度、中度、重度狭窄的敏感度分别为72.16%、65.38%、62.89%,诊断轻度、中度、重度狭窄的特异度、阴性预测值、准确度均较高;冠状动脉CTA、CAG在评估左前降支(LAD)、右冠状动脉(RCA)不同程度狭窄一致性较好(Kappa值分别为0.788,0.729,P均<0.001),评估左回旋支(LCX)不同程度狭窄一致性一般(Kappa值=0.596,P<0.001);冠状动脉CTA评估LAD、LCX、RCA血管轻度、中度、重度狭窄时,其特异度、准确度、阴...     

320排动态容积CT冠状动脉成像对胸痛患者的诊断价值

目的探讨320排动态容积CT冠状动脉成像对胸痛患者冠状动脉狭窄病变及斑块性质的诊断价值。方法对38例因胸痛住院患者先行冠状动脉CT血管造影（CCTA）检查,其中符合冠心病诊断的30例患者于2周内再行冠脉造影（CAG）检查,分析CCTA对冠脉狭窄病变的诊断价值;将冠心病患者分为稳定性心绞痛（SAP）组和急性冠脉综合征（ACS）组,根据不同CT值,将冠状动脉斑块分为软斑块、混合斑块、钙化斑块3类,观察3类斑块在两组患者中的不同构成。结果以CAG为金标准,CCTA对冠脉狭窄诊断的敏感性为91.84%,特异性97.83%,阳性预测值93.75%,阴性预测值97.12%,正确率96.26%,两种检查方法在诊断冠状动脉狭窄病变上差异无统计学意义;两种检查方法对冠脉狭窄程度的判断具有较好一致性（Kappa值=0.829）;ACS患者以软斑块为主（55.9%）,而SAP患者以钙化斑块为主（65%）,差异有统计学意义。结论 CCTA能准确诊断有意义的冠状动脉狭窄病变,且对冠状动脉斑块性质的判断有一定意义,CT值较低的软斑块与ACS有联系。     

128层螺旋CT冠状动脉成像与选择性冠状动脉造影诊断冠心病价值的比较

目的 评价128层螺旋CT(MSCT)冠状动脉成像诊断冠状动脉疾病的价值.方法 对临床怀疑或确诊冠心病的非选择性连续78例患者进行128层MSCT冠状动脉成像,其中有15例患者既往置入冠状动脉支架.以选择性冠状动脉造影结果作为评价标准,探讨128层MSCT在诊断冠状动脉疾病及评价支架后再狭窄的临床价值.结果 基于冠状动脉血管节段分析,879个冠状动脉节段中有821节段(93%)进入统计学分析,128层MSCT诊断冠状动脉病变的敏感性87%,特异性97%,阳性预测值83%,阴性预测值97%.对15例共置入22个支架的患者中,有4个(18%)支架MSCT图像显示支架伪影,图像模糊,未能判断支架内血管腔通畅情况,其余18个支架MSCT结果与选择性冠状动脉造影比较,MSCT诊断支架再狭窄的敏感性为100%,特异性77%,阳性预测值63%,阴性预测值100%.结论 128层MSCT冠状动脉成像对冠状动脉疾病的诊断和支架再狭窄的评价具有较高价值,可以作为一项无创检查技术用于对临床怀疑为冠心病的患者进行筛查.     

100 kV管电压双源CT冠状动脉血管成像诊断冠心病的临床价值

目的探讨100 kV管电压双源CT冠状动脉血管成像诊断冠心病的临床价值。方法收集我院93例行冠状动脉CT血管成像(CCTA)与冠状动脉数字减影血管造影(DSA)检查的冠心病病人影像学资料,以DSA结果为金标准,共分析评价1 400节段冠状动脉。结果 CCTA显示冠状动脉狭窄0～Ⅳ级分别为945节段、155节段、104节段、183节段和13节段;DSA诊断冠状动脉狭窄0～Ⅳ级分别为988节段、112节段、125节段、153节段、22节段。CCTA诊断冠状动脉狭窄敏感性为94.67%(284/300),特异性为97.45%(1 072/1 100),阳性预测值为91.03%(284/312),阴性预测值为98.53%(1 072/1 088),准确率为96.86%(1 356/1 400)。CCTA与DSA诊断冠状动脉狭窄的一致性检验Kappa值为0.72。结论 100 kV管电压双源CT冠状动脉血管成像诊断冠状动脉狭窄具有较高的敏感性和特异性,能显示狭窄病因,可作为疑似冠心病病人的首选检查方法。     

多层CT评价邻近支架冠状动脉血管段的临床研究

目的 评价多层CT(MSCT)诊断邻近支架冠状动脉血管段狭窄的价值.方法 时2003年8月至2006年12月首都医科大学附属北京朝阳医院心脏中心62例成功经皮冠状动脉介入治疗(PCI)术后(共植入80枚支架)的患者,于随访期同时行MSCT冠状动脉成像和冠状动脉造影(CAG)检查,把两种成像技术对临近支架的冠状动脉血管段狭窄程度的测量结果 进行对比.结果 80个邻近支架冠状动脉血管段有57段(71.25%)可供研究;不能评价的主要原因是移动伪影(13/23,57%)和严重钙化(8/23,35%).直径的测量结果 ,MSCT和CAG比较差异有统计学意义[(2.52±0.7)mm比(2.79±0.73)mm,配对差均值(0.28±0.64)mm,P＜0.05].MSCT正确诊断5个狭窄节段,漏诊1例,其评价邻近支架冠状动脉狭窄的敏感性、特异性、准确度、阳性预测值、阴性预测值分别为83%、93%、93%、56%、98%.结论 MSCT诊断邻近支架节段冠状动脉狭窄具有很高的准确度.影响MSCT诊断特性的主要因素是运动伪影和冠状动脉弥漫性钙化.     

320层容积冠状动脉CT血管成像在冠心病诊断中的应用

目的探讨320层容积冠状动脉CT血管成像(CTA)诊断冠心病的准确性。方法 95例患者在行冠状动脉CTA检查后2周内行冠状动脉造影(CAG)检查,以CAG为金标准,判断冠状动脉CTA诊断冠状动脉中度狭窄(狭窄≥50%)及重度狭窄(狭窄≥75%)的敏感性、特异性、阳性预测值、阴性预测值及准确性。结果 CAG显示的1180个冠状动脉节段中,CTA显示中度狭窄的节段共98段;CAG显示80段,CTA诊断中度狭窄的敏感性、特异性、阳性预测值、阴性预测值分别为87.50%、97.45%、71.43%、99.01%,准确性为96.78%;CTA显示重度狭窄的节段共206段;CAG显示207段,CTA诊断重度狭窄的敏感性、特异性、阳性预测值、阴性预测值分别为93.33%、98.66%、93.78%、98.56%,准确性为97.71%。结论320排容积CTA诊断冠心病受心率影响小,诊断准确性高,可以作为冠心病的筛选检查。     

Comparison of coronary flow velocity reserve measurement by transthoracic Doppler echocardiography with 320-row multidetector computed tomographic coronary angiography in the detection of in-stent restenosis in the three major coronary arteries

We sought to compare the diagnostic accuracy and feasibility of coronary flow velocity reserve (CFVR) measurement using transthoracic Doppler echocardiography (TTDE) and 320-row multidetector computed tomographic coronary angiography (CTCA) for predicting in-stent restenosis (ISR). We enrolled 126 consecutive patients with 309 implanted coronary stents in the 3 major coronary arteries. TTDE and CTCA were performed within the 2-week period before follow-up invasive coronary angiography. Binary ISR was defined as percent diameter stenosis ≥50% on invasive coronary angiogram. A CFVR <2.0 using TTDE and a narrowing of ≥50% measured with CTCA were the thresholds indicating the presence of binary ISR. Presence of ISR using invasive coronary angiography was observed in 26 (8%) stents and 26 (14%) vessels. Feasibilities of CFVR measurement and CTCA for predicting ISR in the 3 major vessels were 94% and 91%, respectively. A CFVR <2.0 revealed a 95% diagnostic accuracy with sensitivity of 87%, specificity of 96%, positive predictive value of 77%, and negative predictive value of 98%. Diagnostic accuracy of CTCA was comparable to that of CFVR measurement; however, CTC angiographic results were confounded by metal artifacts in the assessment of small-diameter stents. In conclusion, noninvasive CFVR measurement has high feasibility and accuracy for predicting ISR and is comparable to 320-row CTCA.     

双源计算机断层扫描成像在冠状动脉小血管支架内再狭窄的应用价值

目的探讨双源计算机断层扫描冠状动脉造影术(dual source computed tomography coronary angiography,DSCT-CA)在冠状动脉小血管支架内再狭窄的应用价值。方法对76例(男59例,女17例)有胸闷、胸痛的患者在术后6～12个月行经皮冠状动脉造影后行DSCT-CA检查。根据心率及造影结果将患者分成不同的组别:心率≤70次/min组[n=48,扫描时心率(58±5)次/min]与心率﹥70次/min组[n=41,扫描时心率(78±9)次/min];简单病变组(单个支架,n=54)与复杂病变组(重叠支架及分叉支架,n=35);右冠状动脉组(n=33)、左回旋支组(n=43)和左前降支组(n=13),并比较分析DSCT-CA对各组诊断的敏感性、特异性及阳性预测值、阴性预测值。结果76例患者共植入89个支架,其中31.4%(28/89)的支架经血管造影证实有再狭窄。DSCT-CA对支架内再狭窄的敏感性、特异性及阳性预测值、阴性预测值分别为89%、87%、76%和95%。DSCT-CA对心率≤70次/min组与心率﹥70次/min组的诊断价值比较,差异无统计学意义(P>0.05)。DSCT-CA对冠状动脉三主支的诊断价值比较,差异也无统计学意义(P>0.05)。DSCT-CA诊断复杂病变组的敏感性、阳性预测值、特异性,阴性预测值均低于简单病变组,差异有统计学意义(83%vs.94%,P<0.05;63%vs.88%,P<0.05;74%vs.95%,P<0.05;89%vs.97%,P<0.05)。简单病变组组内分析结果显示,其敏感性和特异性比较,差异无统计学意义(94%vs.95%,P>0.05);阳性预测值低于阴性预测值,差异有统计学意义(88%vs.97%,P<0.05)。4年的质控分析结果显示,DSCT-CA检测小血管支架内再狭窄率呈逐年上升趋势,2006年及2007年再狭窄率均在平均水平以下,2009年超出了平均水平的一倍。结论DSCT-CA可作为小血管支架术后再狭窄的筛选手段,阴性者可排外支架内再狭窄,阳性者需进一步行冠状动脉造影以明确诊断。     

MSCT冠状动脉成像在冠状动脉支架置入术后的应用

目的 探讨64排螺旋CT （MSCT）冠状动脉成像在冠状动脉支架置入后的应用价值.方法 分析行冠状动脉支架置入术后于我院2011年9月至2013年8月期间行64排MSCT冠状动脉成像的患者47例.用评分的方法客观评估多层螺旋CT血管造影（MSCTA）对冠状动脉支架的显示情况,并对支架管腔狭窄情况进行评估测量.对于中重度狭窄的患者进一步行DSA检查,并分析其与MSCTA评估结果的相关性.结果 47例患者共置入89枚冠状动脉支架,其中评为3分的支架为39枚,评为2分的支架为41枚,评为1分的支架为9枚.39枚支架没有发现狭窄,24枚支架轻度狭窄,15枚支架中度狭窄,11枚支架重度狭窄.DSA与MSCTA对中、重度狭窄的评估呈高度正相关,相关系数为r=0.804.伴钙化支架组MSCTA中、重度狭窄评估结果与DSA评估结果呈中度相关,相关系数为r=0.603.结论 MSCT冠状动脉成像能够很好地显示冠状动脉支架及其管腔狭窄,具有重要的临床价值.支架局部的钙化是影响评估准确性的因素之一.     

双源CT对冠状动脉支架靶血管再狭窄的诊断价值

目的:探讨双源CT（DSCT）对冠状动脉支架置入靶血管再狭窄的诊断价值。方法:对我院69例冠状动脉支架置入患者（共111枚支架）进行DSCT,评价支架图像质量得分与靶血管级别的相关性;并对部分患者同期进行冠状动脉造影（CAG）检查,对比分析DSCT对冠状动脉支架置入靶血管病变的真实性。结果:DSCT支架图像质量得分与靶血管级别正相关;DSCT对支架靶血管再狭窄诊断的灵敏度82%、特异度98%、和准确度95%;DSCT与CAG对不同直径支架的靶血管再狭窄检出率差异无统计学意义,但DSCT对直径≥3.0 mm支架靶血管再狭窄检出的特异度和准确度明显高于直径＜3.0 mm支架靶血管的相应指标（均P＜0.05）,而灵敏度的差异未达到显著水平。结论:DSCT可清晰的显示冠状动脉支架靶血管的病变情况,能较准确地评价冠状动脉支架靶血管再狭窄的发生,具有临床应用价值。     

64排螺旋CT冠状动脉成像对冠心病合并糖尿病患者冠脉病变的诊断价值研究

目的评价64排螺旋CT冠状动脉成像在冠心病（CAD）合并糖尿病患者冠状动脉病变诊断中的价值。方法345例应用64排螺旋CT疑诊为CAD的糖尿病患者,以冠状动脉造影（CAG）结果为金指标,评价64排螺旋CT在CAD诊断中的价值。对3568支冠状动脉血管进行选择性CAG检查,将两种方法的检查结果进行对照分析。结果64排螺旋CT对冠状动脉狭窄的诊断与CAG比较,差异无统计学意义（P〉0．05）。64排螺旋CT显示多排螺旋CT血管造影（MSCTA）诊断冠状动脉狭窄有较高的敏感性、特异性、阳性预测值及阴性预测值。结论64排螺旋CT冠状动脉成像技术是一项可靠的CAD诊断方法,作为一项非创伤性检查技术,是评价冠状动脉病变的重要手段。     

冠状动脉CT成像和平板运动试验对冠心病的诊断价值

目的探讨冠状动脉CT成像(CTCA)和平板运动试验(TET)对冠心病的诊断价值。方法选择怀疑冠心病并于2周内分别行CTCA、TET及冠状动脉造影检查的患者共254例,以冠状动脉造影结果为对照指标,分析CTCA、TET及两者联合时对冠心病的诊断价值。结果 TET、CTCA及CTCA联合TET的敏感性、特异性、阳性预测值、阴性预测值和准确率分别为:60.8%、64.7%、82.5%、37.6%和61.8%;84.9%、80.9%、92.4%、66.3%和83.9%;88.3%、86.0%、94.2%、74.0%和87.7%。CTCA对左主干病变的检出率明显高于冠状动脉造影(P<0.01)。结论 CTCA和CTCA联合TET在诊断冠心病时的准确率比单独TET高,CTCA对左主干病变的检出更有一定优势。因此,临床上可将CTCA作为可疑冠心病患者的筛查方法之一。     

Diagnostic accuracy of coronary in-stent restenosis using 64-slice computed tomography: comparison with invasive coronary angiography.

OBJECTIVES: This study sought to evaluate the diagnostic accuracy of coronary binary in-stent restenosis (ISR) with angiography using 64-slice multislice computed tomography coronary angiography (CTCA) compared with invasive coronary angiography (ICA). BACKGROUND: A noninvasive detection of ISR would result in an easier and safer way to conduct patient follow-up. METHODS: We performed CTCA in 81 patients after stent implantation, and 125 stented lesions were scanned. Two sets of images were reconstructed with different types of convolution kernels. On CTCA, neointimal proliferation was visually evaluated according to luminal contrast attenuation inside the stent. Lesions were graded as follows: grade 1, none or slight neointimal proliferation; grade 2, neointimal proliferation with no significant stenosis (<50%); grade 3, neointimal proliferation with moderate stenosis (> or =50%); and grade 4, neointimal proliferation with severe stenosis (> or =75%). Grades 3 and 4 were considered binary ISR. The diagnostic accuracy of CTCA compared with ICA was evaluated. RESULTS: By ICA, 24 ISRs were diagnosed. Sensitivity, specificity, positive predictive value, and negative predictive value were 92%, 81%, 54%, and 98% for the overall population, whereas values were 91%, 93%, 77%, and 98% when excluding unassessable segments (15 segments, 12%). For assessable segments, CTCA correctly diagnosed 20 of the 22 ISRs detected by ICA. Six lesions without ISR were overestimated as ISR by CTCA. As the grade of neointimal proliferation by CTCA increases, the median value of percent diameter stenosis increased linearly. CONCLUSIONS: Binary ISR can be excluded with high probability by CTCA, with a moderate rate of false-positive results.     

双源CT在冠状动脉支架内再狭窄诊断中的价值

目的 参照定量冠状动脉造影结果,评价双源CT在冠状动脉支架内再狭窄诊断中的价值.方法 对55例支架术后出现胸闷、胸痛的冠心病患者,在术后6～12个月行双源CT检查及定量冠状动脉造影.以定量冠状动脉造影结果为参照,评价双源CT诊断支架内再狭窄的真阳性、真阴性、假阳性、假阴性,并计算敏感性、特异性、阳性预测值、阴性预测值.分析心率、置人支架情况对双源CT诊断性能的影响.结果 55例患者共置入89枚支架,其中31.5%(28/89)的支架经冠状动脉造影证实发生支架内再狭窄.双源CT诊断支架内再狭窄的敏感性、特异性、阳性预测值、阴性预测值分别为89%、87%、76%和95%.双源CT诊断心率＜70次/min及≥70次/min患者支架内再狭窄的敏感性(94%比82%)、特异性(88%比90%)、阳性预测值(76%比75%)、阴性预测值(97%比93%)差异无统计学意义(P＞0.05).双源CT诊断重叠支架、分叉部位支架与单支架再狭窄的敏感性(84%比100%)、特异性(81%比96%)、阳性预测值(70%比90%)和阴性预测值(91%比100%)差异无统计学意义(P＞0.05).双源CT诊断直径≥3.50 mm支架、直径3.00 mm支架和直径≤2.75mm支架发生再狭窄的特异性(分别为100%、80%和66%,P＜0.05)和阳性预测值(分别为100%、95%和53%,P＜0.05)差异有统计学意义.结论 双源CT对大直径支架的再狭窄有较好的诊断性能,且不受心率和支架分布情况的影响.

Abstract：

Objective To evaluate the value of dual source computed tomography coronary angiography(DSCT-CA)on detecting in-stent restenosis(＞ 50% luminal narrowing)in symptomatic patients referred for quantitative coronary angiography(QAC). Methods Fifty five patients(43 males)with chest pain after coronary stent implantation within 6 - 12 months were evaluated by DSCT-CA and QAC. The sensitivity, specificity, positive predictive value(PPV)and negative predictive value(NPV)of DSCT-CA were calculated using coronary angiography as gold standard. Results Eighty nine stents were implanted.In-stent restenosis was evidenced in 28 stents(31.5%)by QAC. The sensitivity, specificity PPV and NPV of DSCT-CA for the diagnosis of in-stent restenosis was 89%, 87%, 76% and 95%, respectively.Diagnostic efficiency was not affected by heart rate and the sensitivity was 0. 94 vs. 0.82, the specificity 0. 88 vs. 0. 90, the PPV 0. 76 vs. 0.75 and the NPV 0. 97 vs. 0. 93(all P ＞ 0. 05)between patients with heart rate ＜70 beats/min and patients with heart rate≥70 beats/min. The sensitivity(84% vs. 100%),specificity(81% vs. 96%), PPV(70% vs. 90%)and NPV(91% vs. 100%)were similar between overlapping or bifurcations stents and single stents. The specificity(100% vs. 80% vs. 66%)and PPV (100% vs. 95% vs. 53%)were significantly higher in the groups with stents ≥3.50 mm, stents 3.00 mm than in stents ≤2. 75 mm(both P ＜ 0. 05). Conclusion Diagnostic efficiency of in-stent restenosis with DSCT-CA in the large diameter stent is better than in the small diameter stent and the diagnosis efficacy is not affected by heart rate and stent distribution.     

吡格列酮对非糖尿病患者冠状动脉药物洗脱支架内再狭窄的影响

目的探讨吡格列酮对非糖尿病患者冠状动脉（冠脉）支架内再狭窄的影响及其可能的机制。方法选择置入雷帕霉素药物洗脱支架的非糖尿病患者,随机分成治疗组48例和对照组41例,治疗组在对照组常规治疗的基础上加用吡格列酮（30mg,qd）。冠脉支架置入术后6～8个月行选择性冠脉造影术,并于治疗前及随访6～8个月复查时分别测定血脂、空腹血糖,空腹胰岛素,并计算胰岛素抵抗指数（HOMA-IR）。结果冠脉支架置入术后6～8个月,治疗组支架内再狭窄的患者0例（0%）,对照组5例（12.20%）,两组比较有统计学差异（P〈0.05）。两组患者术后6～8个月分别与治疗前比较,血脂指标均明显降低（P〈0.05或P〈0.01）,空腹血糖均无明显变化（P〉0.05）,HOMA-IR治疗组较治疗前明显降低（P〈0.01）,而对照组无明显变化（P〉0.05）。治疗组与对照组比较,血脂指标、空腹血糖在治疗前及术后6～8个月均无显著性差异（P均〉0.05）,而HOMA-IR在治疗前无显著性差异（P〉0.05）,术后6～8个月治疗组却较对照组降低（P〈0.05）。结论吡格列酮可以防止非糖尿病患者药物洗脱支架的再狭窄,增加胰岛素敏感性,可能是吡格列酮防止洗脱支架内再狭窄的机制之一。     

Chest pain after coronary artery stent implantation

A sizeable proportion of patients who undergo successful coronary artery stent implantation experiences chest pain immediately after the procedure and/or in the following months in the absence of in-stent restenosis. We investigated this phenomenon in 57 consecutive patients with stable angina who underwent successful stent implantation. Chest pain characteristics were assessed before stent implantation and during 6-month follow-up. All patients underwent coronary angiography within 6 months of the procedure 48 hours after exercise thallium-201 perfusion scintigraphy. Patients who did not exhibit in-stent restenosis underwent an ergonovine test at the end of routine coronary angiography. During follow-up, 15 patients complained of chest pain. Six of these patients exhibited scintigraphic evidence of myocardial ischemia and in-stent restenosis at angiography. In the remaining 9 patients, chest pain occurred in the absence of in-stent restenosis at angiography. In 8 of these patients intracoronary ergonovine administration reproduced their habitual pain, whereas it did not cause any pain in the 42 patients who were completely asymptomatic at follow-up and without in-stent restenosis. Ergonovine caused more intense vasoconstriction and nitroglycerin caused more intense vasodilation of the reference coronary diameter in patients with than in patients without ergonovine-induced pain (-17 +/- 3 vs -9 +/- 3%, p <0.001; 9 +/- 6 vs 5 +/- 4%, p <0.02, respectively). In conclusion, chest pain with features similar to habitual angina occurs in the absence of in-stent restenosis in 1/5 of patients after stent implantation and appears to be associated with more intense coronary vasoreactivity.