Application Of Multi-slice Spiral Computed Tomography For Diagnosis Of Left Main Coronary Disease

Objective: Compare the values of multi-slice spiral computed tomography Coronary Angiography(MSCTA) and Coronary Angiography(CAG) in diagnose left main coronary artery(LMCA),and the role of MSCTA in diagnose LMCA diseases,and the Use of MSCT to ananlyse and discuss the qualitative value in coronary artery plaque.Methods: a total of 301patients(173males,128 females,mean age [60.7+11.8] yeas) were examined with MSCTA and CAG in Cang Zhou Central Hospital during Jan.2013 to Dec.2014.The MSCT and CAG were examined at the same week. The LMCA was divided into three parts,The Opening(The lesion were located in 3mm to the opening of the left main coronary artery)、Middle part、 and Distal(The lesion were located in 3mm before the end of the left main bifurcation).Compared the sensitive,specificitie,positive(PPV) and negative predictive values(NPV) for diagnosis LMCA of the MSCTA and CAG, taken the CAG as the golden standard,compared the evaluation of the MSCTA with CAG in the coronary artery plaque;Observe the relationship between the composition of coronary artery plaque and The degree of coronary artery stenosis;Observe Whether there are deference between different degree of coronary artery stenosis use the MSCT to diagnose coronary artery disease;At the same time,compared with MSCTA in diagnose each segment lesions of the LMCA、LAD、LCA,and observe the differences.Results: The sensitivity,specificity,PPV,NPV of MSCTA in diagnose LMCA diseases were 90.6%,99.2%,93.5%,98.9%;Kappa index was 0.909(P>0.05),taken the result of CAG as the gold standard.MSCTA and CAG have the same result for diagnose The Opening and The Middle part of LMCA;with a high degree of The Distal of LMCA;The sensitivity,specificity,PPV,NPV of MSCTA in detecting the Distal part of the LMCA disease were 87.5%,99.6%,87.5%,99.7%;Kappa index was 0.872.Compare MSCT and CAG, MSCT is more sensitive in diagnose of the LMCA calcified lesions, and the statistical significance is obvious.The degree of luminal stenosis is different between Calcified plaque and the fiber plaque with lipid plaque,Calcified plaque is moestly occure in the Mild and moderate luminal stenosis,the fiber plaque and lipid plaque are moestly occur in the Severe luminal stenosis;The accuracy of MSCT diagnose Coronary artery disease is correlated with the distance of the Plaque and Left main root,The shorter, the more accurate;The accuracy of MSCT in diagnose the moderate and severe stenosis(50%~99%) is higher than the mild stenosis,But there is no statistical significance;Use MSCTA diagnose LMCA plaque is better than LAD plaque and LCA plaque.Conclusion: MSCTA have a higher accuracy in diagnose LMCA disease,the correlation is excellent between the quantitative assessment of MSCTA and CAG,The result of The Sensitivity and The negative predictive value in diagnose coronary artery plaque is excellent。Compared MSCTA and CAG,The first: MSCTA and CAG have the same result in diagnose The Opening and The Middle part of LMCA;The second :The accuracy of MSCT diagnose Coronary artery disease is Correlated with the distance of the Plaque and the Left main root,More shorter,more accurate.MSCTA is useful in distinguishing out unstable plaque which is have High-risk.MSCTA is an important tool in diagnose LMCA diseases.