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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