The Comparative Study Of Coronary CT And Coronary Angiography In The Diagnosis And Treatment Of Coronary Heart Disease(CHD)

Objectives Evaluation of 64-slice Computed Tomoronary Angiography(CTA)’s diagnostic value and related influencing factors of coronary stenosis, follow-up of stent and bypass surgery.Methods Selected 274 cases(168 cases of screening for coronary heart disease, 68 cases of post operation of coronary stenosis and 38 cases of bypass surgery) received CTA and Coronary Angiography examination respectively. Regarding the angiography report as the Gold standard to comparatively analysis the two test results. Evaluation of the coronary CTA used in the diagnosis with sensitivity, specificity degree, positive(negative) predictive value of coronary artery stenosis, in-stent restenosis and patency of coronary artery bypass graft and the accuracy of diagnosis of plaque and the related factors. The two results of CAG and CTA using matched fourfold table or data line(R) ×column(C) c 2 test comparatively analysis of the list, if P> 0.05, then there was no statistically significant and cannot yet considered the existence of two checks statistically significant, that can be used as a coronary CTA, the higher the accuracy of imaging applications in the diagnosis and treatment of patients with coronary heart disease, and vice versa.Results 1 Group of Screening for CHD: there were 123 and 125 patients were diagnosed with coeonary heart diease by the CAG and CTA respectively,in which 120 cases were diagnosed by the two methods.There is no significant difference between the two methods in the diagnosis of coronary artery stenosis and plaque qualitative and on the good correlation. The Coronary CTA with accuracy of diagnosis of the various aspects, the number of patients, number of diseased vessels, particularly coronary artery(LAD, LCX, RCA, etc.) is: 95.2%, 93.5%, 94.6%, 93.5%, 92.2%.2 Group of follow-up of stent: 10 of 145 stents were excluded due to the less clear of CTA image. In the 135 evaluable stents, 11(8.1%) stents were diagnosed ISR by CAG, of which 10(7.4%)correctly diagnosed ISR by CTA, one was missed diagnosis; nine cases of misdiagnosed(eight cases in which the diameter of stent≤2.75mm). The Coronary CTA with accuracy of diagnosis of LAD, LCX, RCA positions and the stent with diameter>2.75 mm and length≤30mm respectively: 94.3%, 87.1%, 93.9%, 99.0% and 96.5%; Restenosis rate of stents with diameter less than 2.75 mm was significantly higher than the diameter of greater than 3mm. The restenosis rate of stent with length greater than 30 mmm was significantly higher than the one with length less than 18 mm. 3 Group of bypass surgery: 38 cases of CABG with 73 evaluable grafts(2 of 75 cases are excluded because CTA cannot evaluated), 14 patients with graft lesions were detected by CAG examination(18vascular lesions, including two arterial grafts and 16 vein grafts). CTA correctly detected12 cases, missed diagnosis 2 and misdiagnosed 2(the arterial grafts are all correctly detected, vein grafts correctly detected 14, missed 2 and misdiagnosis 2); In the evaluation of graft patency by CTA, in accordance with the number of cases, arterial grafts and venous grafts and other aspects, the accuracy were 89.5%, 100.0%, 91.1%;The long-term patency of internal mammary artery is much higher than saphenous vein grafts;Surgery in patients with age, sex and integrated associated risk factors will affect the bridge vascular patency rate.Conclusions 1 CTA examination in the diagnosis of coronary artery stenosis, plaque qualitative, in-stent restenosis and graft patency has a very high accuracy. CTA can preliminarily determine the property of the plaque. But it has low determination for unstable plaque. 2 Coronary CTA check contrast agent dosage 2~3 times that of the CAG,patients with a history of renal insufficiency of applications need to be careful.3 So far CTA still can not completely replace the CAG in the clinical application. But it should be used as the complementary, atraumatic and non-invasive imaging methods for early screening and post-treatment of coronary heart disease patients.CTA especially applies to be used in the following aspects: 1 diagnosis of the suspected coronary artery disease, predict prognosis in patients with coronary heart disease;2 Found that early LM vessel lesions;3 not exclude aortic dissection or pulmonary embolism in patients with chest pain triple-stop inspection;4 after 1 year of PCI surgery follow-up of the patients with no obvious symptoms; 5 evaluation of graft patency of after surgery of CABG.