Abstract 12446: Diagnostic Accuracy of 64-Slice Multislice Computed Tomography to Assess Coronary Stent Thrombosis as Determined by Intravascular Optical Coherence Tomography
Objectives The purpose of this study was to evaluate the diagnostic accuracy of 64-slice multislice computed tomography (MSCT) to detect stent thrombosis as determined by intravascular optical coherence tomography (OCT).
Background Coronary stent thrombosis remains a potential complication after stent implantation. Noninvasive thrombus imaging might be beneficial for both diagnosis and guidance of therapy in patients with chest pain after coronary stent implantation.
Methods We performed MSCT before OCT in 79 patients with chest pain within 1 month (median =12 days, range = 7 to 18 days) after coronary stent implantation. The median interval between MSCT and OCT was 36 minutes (range = 34 to 41 minutes). In MSCT, the thrombus was identified as a moderate to severe hypodense legion within the stent. In OCT, the thrombus was defined as a mass protruding beyond the stent struts into the lumen with significant OCT signal attenuation behind the mass.
Results Stent thrombosis was identified in 21 patients by OCT. MSCT correctly identified 20 patients with stent thrombosis but misclassified 5 patients. Four patients with false-positive MSCT scan had stents with a diameter of 2.5 mm. One patient with false-negative MSCT scan had a small thrombus that had a measured dimension <1.0 mm in OCT. The sensitivity, specificity, and positive and negative predictive values were 95%, 93%, 83%, and 98%, respectively. Intraobserver and interobserver agreement in the MSCT assessment of stent thrombosis yielded excellent concordance (κ-value = 0.98 and κ-value = 0.88, respectively).
Conclusions MSCT correctly identified the presence of thrombus in the stented segments in good agreement with OCT, and the negative predictive value was notably high. Our results suggest a potential role for MSCT to exclude stent thrombosis in patients presenting with chest pain early after stent implantation.
- © 2011 by American Heart Association, Inc.