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Dual-source coronary computed tomography angiography for detecting in-stent restenosis
  1. Francesca Pugliese (francesca.pugliese{at}libero.it)
  1. Erasmus MC University Medical Center Rotterdam, Netherlands
    1. Annick C Weustink
    1. Erasmus MC University Medical Center Rotterdam, Netherlands
      1. Carlos Van Mieghem
      1. Erasmus MC University Medical Center Rotterdam, Netherlands
        1. Filippo Alberghina
        1. Erasmus MC University Medical Center Rotterdam, Netherlands
          1. Masato Otsuka
          1. Erasmus MC University Medical Center Rotterdam, Netherlands
            1. Willem Bob Meijboom (w.b.meijboom{at}erasmusmc.nl)
            1. Erasmus MC University Medical Center Rotterdam, Netherlands
              1. Niels Van Pelt
              1. Erasmus MC University Medical Center Rotterdam, Netherlands
                1. Nico R Mollet
                1. Erasmus MC University Medical Center Rotterdam, Netherlands
                  1. Filippo Cademartiri
                  1. Erasmus MC University Medical Center Rotterdam, Netherlands
                    1. Gabriel P Krestin
                    1. Erasmus MC University Medical Center Rotterdam, Netherlands
                      1. Myriam G M Hunink
                      1. Erasmus MC University Medical Center Rotterdam, Netherlands
                        1. Pim J de Feyter (p.j.defeyter{at}erasmusmc.nl)
                        1. Erasmus MC University Medical Center Rotterdam, Netherlands

                          Abstract

                          Objective To evaluate the performance of Dual source CT coronary angiography (DSCT-CA) in the detection of in-stent restenosis (≥50% luminal narrowing) in symptomatic patients referred for conventional angiography (CA).

                          Design / Patients We prospectively evaluated 100 patients (78 males, age 62 ± 10) with chest pain after coronary stenting. DSCT-CA was performed before CA.

                          Setting Many patients undergo coronary artery stenting; availability of a non-invasive modality to detect in-stent restenosis would be desirable.

                          Results Average heart rate (HR) was 67 ± 12 (range 46-106) beats per minute (bpm). There were 178 stented lesions. The interval between stenting and inclusion in the study was 35 ± 41 (range 3-140) months. Thirty-nine/100 (39%) patients had angiographically proven restenosis. Sensitivity, specificity, PPV and NPV of DSCT-CA, calculated in all stents, were 94%, 92%, 77% and 98%, respectively. Diagnostic performance at HR <70bpm (n=69; mean 58 bpm) was similar to that at HR ≥70bpm (n=31; mean 78 bpm); diagnostic performance in single stents (n=95) was similar to that in overlapping stents and bifurcations (n=83). In stents ≥3.5mm (n=78), sensitivity, specificity, PPV, NPV were 100%; in 3mm stents (n=59), sensitivity and NPV were 100%, specificity 97%, PPV 91%; in stents ≤2.75mm (n=41), sensitivity was 84%, specificity 64%, PPV 52%, NPV 90%. Nine stents ≤2.75mm were uninterpretable. Specificity of DSCT-CA in stents ≥3.5mm was significantly higher than in stents ≤2.75mm (OR = 6.14; 99%CI: 1.52-9.79).

                          Conclusion DSCT-CA performs well in the detection of in-stent restenosis. Although DSCT-CA leads to frequent false positive findings in smaller stents (≤2.75mm), it reliably rules-out in-stent restenosis irrespective of stent size.

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