Abstract 2328: Clinical Value Of Ct Coronary Angiography In Symptomatic Patients After Percutaneous Coronary Intervention.
Introduction and hypothesis: CT coronary angiography (CTCA) is increasingly used for non-invasive coronary artery imaging. Patients with recurrent chest pain after percutaneous coronary intervention (PCI) are traditionally investigated using exercise stress testing (XT), myocardial perfusion imaging (MPI) and stress echo (SE) or by direct referral for an invasive coronary angiogram (ICA). The aim of the present study is to compare this traditional work-up (TWU) with a CT based strategy (CBS).
Methods: Thirty-three symptomatic patients underwent dual-source cardiac CT (DSCT) before undergoing invasive coronary angiography. Inclusion criteria were the following: previous PCI with use of large-diameter stents (stent diameter ≥3mm) and absence of previous bypass surgery. All angiograms were evaluated for in-stent restenosis and the presence of disease progression at non-PCI sites. Significant disease was defined by quantitative coronary angiography (QCA) as the presence of > 50% lumen diameter stenosis. Diagnostic accuracy of CTCA for detection of significant disease was computed using QCA as reference and compared with the diagnostic accuracy of a TWU using one of the following 4 approaches: XT, MPI, SE or direct referral for ICA.
Results: According to QCA, 29/33 patients (87%) presented with restenosis (10 patients) or native vessel disease (19 patients). The TWU resulted in a diagnostic accuracy of 73%: a false negative result was present in 7/9 patients, a false positive result was present in 2/24 patients. A CTS resulted in a diagnostic accuracy of 91%: one patient (1/3) presented with a false negative scan, 2 patients (2/30) had a false positive result. Revascularization was performed in 27/29 patients: 6/27 patients who underwent revascularization were not identified based on a TWU. By contrast, a CTS resulted in a correct identification of all 27 patients.
Conclusion: Compared with a traditional work-up, a CT-based strategy in selected symptomatic patients after previous PCI results in a better triage of patients before undergoing an invasive coronary angiogram.