| BackgroundCoronary heart disease is seriously threatening human life and health,and its early diagnosis and treatment are very important.At present,the main methods for assessment of coronary artery stenosis and diagnosis of coronary heart disease are coronary angiography(CAG)and coronary CT angiography(CCTA).CAG is the"gold standard",but it is an invasive examination and needs to be completed in the operating room with certain risks and relatively high costs.With the rapid development of CT technology,256-slice CT angiography has faster scanning speed and higher spatial and temporal resolution than previous CT imaging.Compared with CAG,256-slice CT angiography has the advantage of being non-invasive and relatively inexpensive.Compared with CAG,the accuracy of 256-slice angiography and its influencing factors are rarely reported.PurposeTo evaluating the accuracy of 256-slice CT angiography in the diagnosis of coronary artery lesions and its influencing factors.Objectives and methods1.ObjectivesThe patients who were diagnosed with chest pain in our hospital from January 2016 to December 2017 were selected as the screening subjects.Patients who met the criteria for inclusion and were able to complete 256-slice CT angiography and CAG were included in the study.There were total 208 research objectives.2.MethodIn this study,the diagnosis of coronary heart disease is at least one vascular diameter stenosis is more than 50%.(1)Taking the patient as the study object,if 256-slice CT angiography shows that one vascular diameter stenosis is more than 50%at least,the diagnosis was coronary heart disease(positive),and in other cases,it was not coronary heart disease(negative).The results were compared with CAG to analyze the accuracy,sensitivity and specificity of 256-slice CT angiography in the diagnosis of coronary heart disease.(2)According to the coronary artery segmentation method of the American Heart Association(AHA),dividing coronary vessels into 15 segments,and taking each vessel segment as the study object.Compared with CAG,the accuracy,sensitivity,and specificity of 256-slice CT angiography in assessing the degree of stenosis in each vessel segment are analyzed.(3)According to the qualitative analysis of 256-slice CT angiography for the plaques,the diseased vessels were divided into calcified,non-calcified,and mixed groups.Compared with CAG,to evaluate whether the accuracy of coronary stenosis has differences with 256-slice CT angiography among these three groups.(4)According to the extent of the lesion,this study classified coronary artery disease into three-vessel disease and non-triple vessel disease.Compared with CAG,to evaluate whether the accuracy of coronary stenosis has differences with 256-slice CT angiography among these two groups.(5)According to whether there is diabetes,the patients were divided into diabetes group and non-diabetic group.Compared with CAG,to evaluate whether the accuracy of coronary stenosis has differences with 256-slice CT angiography among these two groups.(6)According to whether there is hypertension,Patients were divided into hypertension group and non-hypertension group.Compared with CAG,to evaluate whether the accuracy of coronary stenosis has differences with 256-slice CT angiography among these two groups.(7)The degree of coronary stenosis was assessed by the kandall coefficient of concordace to evaluate the concordance between these two methods.(8)Statistical analysis:All data were analyzed by the SPSS23.0 software package and area under the curve(AUC)was used to assess the diagnostic accuracy of coronary CTA.The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of 256-slice angiography in the diagnosis of coronary stenosis were evaluated.Comparisons between two groups and three groups of samples were evaluated by chi-square test.Use the kandall coefficient of concordace to describe the consistency between the two examination methods.The difference was statistically significant at P is less than 0.05.Result(1)Compared with CAG,the accuracy of 256-slice CT angiography in the diagnosis of coronary heart disease was 86.8%,the sensitivity was 98.5%,the specificity was 75.0%,the positive predictive value was 99.5%,and the negative predictive value was 50.0%.(2)Compared with CAG,The accuracy of 256-slice CT angiography to evaluate the RCA1,RCA2,RCA3,PD,LM,LAD1,LAD2,LAD3,D1,LCX1,LCX2,OM were 83.9%,84.6%,77.5%,60.5%,91.6%,83.1%,89.2%,64.3%,73.6%,81.7%,56.7%,59%.D2 were absent because of the small number of vascular segments that could be evaluated.(3)The accuracy of 256-slice CT coronary angiography in the diagnosis of calcified vascular segment was 63.4%,The accuracy of CT in the diagnosis of non-calcified vascular segments was 90.2%,The diagnostic accuracy of CT in mixed vascular segments was 78.3%.256-slice spiral CT angiography showed differences in the accuracy of lesions.Non-calcified lesions were superior to calcified and mixed plaques,and mixed plaques were superior to calcified plaques.(4)The accuracy of 256-slice spiral CT angiography in the diagnosis of coronary stenosis:The accuracy of the three-vessel disease is 84.3%;The accuracy of non-triple vascular lesions is 85.9%.The accuracy of 256-slice spiral CT angiography in assessing the degree of stenosis in coronary artery segment is affected by three-vessel disease,Non-triple disease group was superior to three-vessel disease group.(5)The accuracy of 256-slice spiral CT angiography in diagnosis of coronary artery disease:The accuracy of diabetic patients was 72.8%;the accuracy of non-diabetic patients was 99.7%.The accuracy of 256-slice spiral CT angiography in assessing the degree of stenosis of coronary artery was affected by diabetes,and the non-diabetic group was superior to the diabetic group.(6)The accuracy of 256-slice spiral CT angiography in diagnosis of coronary artery disease:The accuracy of hypertension patients was 73.1%;the accuracy of non-hypertensive patients was 99.7%.The accuracy of 256-slice ultra-fast CT angiography in assessing the degree of stenosis of coronary artery was affected by hypertension,and the non-hypertension group was superior to the hypertension group.(7)256-slice spiral CT angiography has significant consistency with coronary angiography for the proximal and mid of right coronary artery,main left,the proximal and mid of left anterior descending artery,proximal of left circumflex coronary artery,obtuse marginal.There is no significant agreement between 256-slice spiral CT angiography and coronary angiography for the distal of right coronary artery,posterior descending,apical of left anterior descending artery,first diagonal,distal of left circumflex coronary artery.Conclusions1.256-slice spiral CT angiography has higher accuracy,sensitivity,and positive predictive value in diagnosing coronary heart disease,while specificity and negative predictive value are lower.2.The accuracy of 256-slice spiral CT angiography in assessing the vascular stenosis in the proximal and middle segment of the main coronary artery was higher,and the accuracy of the distal vascular was relatively low.3.The accuracy of 256-slice spiral CT angiography in assessing the degree of stenosis in non-calcified lesions is higher than that in calcified lesions and mixed plaque lesions.4.The accuracy of 256-slice spiral CT angiography was superior to non-triple-vessel lesions than three-vessel disease group.5.The accuracy of 256-slice spiral CT angiography in non-diabetic patients was better than that in diabetic patients.6.The accuracy of 256-slice spiral CT angiography in patients with hypertension is inferior to non-combined hypertensive patients.7.For the proximal and middle segments,256-slice spiral CT angiography and coronary angiography are consistent in assessing the severity of coronary lesions. |
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