The Clinical Research Of 16-slice Spiral Computed Tomography Coronary Angiography In The Diagnosis Of Coronary Atherosclerotic Heart Disease

ObjectivesDevelop a rational diagnostic method to detect coronary atherosclerotic heart disease (CAHD) by 16-slice spiral computed tomography coronary angiography (16SCTCA) .Evaluate the clinical value of 16SCTCA to detect CAHD. Compare the diagnostic accuracy of 16CTCA to detect CAHD in women and men, in elder patients and non-elder patients, in patients with syndrome of blood stasis and patients without syndrome of blood stasis.MethodsBoth 16SCTCA and selective coronary angiography (CAG) were performed in 39 patients (34 patients were suspected of CAHD, 5 patients felt chest pain again after coronary artery stenting). A diagnostic method to detect CAHD by 16SCTCA was developed by correlating the 16SCTCA findings with the CAG findings in the first 15 patients (retrospective group). The method subsequently was tested prospectively in the next 24 patients (prospective group). Results were compared with CAG findings which were regarded as gold standard for detecting CAHD.Results①.438 coronary artery segments could be evaluated by 16SCTCA in all the 39 patients.②.The method obtained by correlating the 16SCTCA findings with the CAG findings in retrospective group was used in detecting significant coronary stenosis in prospective group. Among the 24 patients in prospective group, 269 coronary artery segments could be evaluated by 16SCTCA, and 47 significant coronary stenosis segments were found by 16SCTCA.Of them,37 segments were confirmed by CAG,10 segments were false positive .There were also 5 false negative segments in prospective group. So the sensitivity , specificity , positive predict value, negative predict value and accuracy of 16SCTCA to detect significant coronary stenosis were 88.1%, 95.6%, 78.7%, 97.7%, and 94.4% in the prospective group.③.In the prospective group, there were 12 male patients and 12 female patients. The sensitivity, specificity, positive predict value, negative predict value and accuracy of 16SCTCA to detect significant coronary stenosis were 100%, 96.7%, 83.3%, 100%, and 97.2% in man. The sensitivity , specificity , positive predict value, negative predict value and accuracy of 16SCTCA to detect significant coronary stenosis were77.3%, 94.2%, 73.9%, 95.1%, and 91.2% in women. The analysis demonstrated lower negative predict value and accuracy in women compared with men (P<0.05).④.In the prospective group, there were 13 elder patients and 11 non-elder patients. The sensitivity, specificity ,positive predict value, negative predict value and accuracy of 16SCTCA to detect significant coronary stenosis were 92.6%, 92.4%, 73.5%, 98.2%, and 92.5% in elder patients. The sensitivity , specificity , positive predict value, negative predict value and accuracy to detect significant coronary stenosis were 80%, 99.1%, 92.3%, 97.3%, and 96.7% in non-elder patients. The analysis demonstrated lower specificity in elder patients compared with non-elder patients (P<0.05).⑤.In the prospective group, there were 15 patients with the syndrome of blood stasis and 9 patients without the syndrome of blood stasis. The sensitivity, specificity , positive predict value, negative predict value and accuracy of 16SCTCA to detect significant coronary stenosis were 89.7%, 92.8%, 79.5%, 96.7% and 92.1% in patients with the syndrome of blood stasis. The sensitivity , specificity , positive predict value, negative predict value and accuracy of 16SCTCA to detect significant coronary stenosis were 66.7% ,99.0% , 66.7% ,99.0% and 98.1% in patients without the syndrome of blood stasis. The analysis demonstrated lower accuracy in patients with the syndrome of blood stasis compared with patients without the syndrome of blood stasis (P<0.05).⑥.The 16SCTCA could clearly distinguish the quality of coronary plaques and show the location, shape of coronary stents. It could also exactly evaluate coronary stent patency.ConclusionsThe 16SCTCA is a very valuable method in detecting CAHD especially when it is performed in man, in non-elder patients and in patients without the syndrome of blood stasis. As an alternative method it is useful and non-invasive for detecting CAHD in symptomatic patients. It is also very useful in the follow-up investigation of patients who underwent coronary artery stenting.