The diagnostic value of computed tomographic coronary angiography in patients with acute myocardial infarction versus stable angina pectoris: a preliminary report.

Chang Gung medical journal Pub Date : 2011-05-01

Shih-Jen Chen, Li-Tang Kuo, Chao-Hung Wang, Wen-Jin Cherng, Ning-I Yang, Chi-Wen Cheng

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Abstract

Background: Computed tomographic coronary angiography (CTA) is a non-invasive alternative to conventional coronary angiography (CCA) in detecting chronic coronary artery disease (CAD). However, the value of CTA in estimating acute myocardial infarction (AMI) has not been evaluated.

Methods: CTA and CCA were performed on 10 patients with non-ST-elevated AMI and 17 patients with stable angina pectoris. The plaque components and stenosis severity were assessed by both modalities to clarify the diagnostic values of CTA in AMI and stable angina pectoris.

Results: A high total coronary artery calcium (CAC) score was significantly correlated with the presence of CAD and the target lesion CAC score (p < 0.01). The AMI group tended to have a lower target CAC score (p = 0.10) and target plaque burden (p = 0.27), compared to the stable angina pectoris group. To estimate the coronary artery stenotic severity, CTA and CCA had concordant correlations in all segments, except in the proximal left anterior descending (LAD) artery. The calcium score and calcification fraction percentage in the proximal LAD artery were significantly higher than those of other segments (p < 0.01). Compared to CCA, CTA overestimated the severity of stenosis in the proximal LAD arterial segment in the stable angina pectoris group (p = 0.028), but not in the AMI group.

Conclusions: CTA has diagnostic values similar to those of CCA in detecting coronary lesions in patients with AMI or stable angina pectoris. However, a high level of plaque CAC in the stable angina pectoris group may lead to an overestimation of the severity of coronary stenosis, especially in the proximal LAD arterial segment. Although less remarkable, the impact of CAC on the diagnostic value of CTA was still substantial in patients with AMI.

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计算机断层冠状动脉造影对急性心肌梗死与稳定型心绞痛的诊断价值:初步报告。

背景:计算机断层冠状动脉造影(CTA)是传统冠状动脉造影(CCA)检测慢性冠状动脉疾病(CAD)的一种无创替代方法。然而，CTA在评估急性心肌梗死(AMI)中的价值尚未得到评价。方法:对10例非st段抬高型AMI患者和17例稳定型心绞痛患者行CTA和CCA检查。通过两种方式评估斑块组成和狭窄严重程度，以明确CTA在AMI和稳定型心绞痛中的诊断价值。结果:高冠状动脉总钙(CAC)评分与冠心病的存在及靶病变CAC评分有显著相关性(p < 0.01)。与稳定型心绞痛组相比，AMI组往往具有较低的目标CAC评分(p = 0.10)和目标斑块负担(p = 0.27)。为了估计冠状动脉狭窄的严重程度，CTA和CCA在除左前降支(LAD)近端外的所有节段均具有一致的相关性。LAD近端动脉钙评分和钙化分数百分比显著高于其他节段(p < 0.01)。与CCA相比，稳定型心绞痛组CTA高估了LAD近端动脉段狭窄的严重程度(p = 0.028)，而AMI组则没有。结论:CTA与CCA对AMI或稳定型心绞痛患者冠状动脉病变的诊断价值相近。然而，稳定型心绞痛组斑块CAC的高水平可能导致对冠状动脉狭窄严重程度的高估，尤其是在LAD动脉近端段。虽然不太显著，但CAC对AMI患者CTA诊断价值的影响仍然很大。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Chang Gung medical journal

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