Contrast About Diagnostic Values Of 64-Detector Spiral Computed Tomography Coronary Angiography In Female And Male Patients With Coronary Artery Stenosis

Objective:The results of coronary angiography(CAG) as a golden standard,to evaluate whether the diagnostic values of 64-detector spiral computed tomography coronary angiography(64-DSCTCA) are identical between female and male patients with coronary artery stenosis.Methods:Inclusion criteria:In this clinical study, we retrospectively successively collected patients with coronary artery disease(CAD) or suspected CAD(75 males and 75females), who had been examined with not only 64-DSCTCA but also CAG(64-DSCTCA earlier than the CAG, time interval less than 4 weeks)during October 2010 to October 2014 in the Affiliated Hospital of Chengde Medical College, aged 18 years or older. The images 64-DSCTCA and CAG should be clear and complete.Exclusion criteria: Patients after heart valve replacement, artificial permanent cardiac pacemaker implantation, poor contrast material filling.Coronary artery segments was classified according to the guidelines of the American Heart disease Association(AHA), the coronary artery could be divided into 9 segments for evaluation, they are left main coronary artery, the proximal-middle-distal segments of left anterior descending, the proximal-distal segments of left circumflex, the proximal-middle-distal segments of right coronary artery. Adopting the international standard visual method: A=(B-C)/B×100%(A for the degree of coronary artery stenosis, B for normal blood vessel diameter of proximal part of stenosis, C for the diameter of stenosis).Coronary artery disease defined as at least 50% diameter narrowing of a major coronary artery;50%~75% for moderate coronary artery stenosis; Coronary artery stenosis 76%~100% for severe and totally occluded. The CAG was the gold standard, comparison between 64-DSCTCA CT and coronary angiography was performed on a per-segment basis. The diagnostic performance of 64-DSCTCA for the detection of significant stenosis(the stenosis degree ≥ 50%) is presented as sensitivity, specificity, positive predictive value, negative predictive value in female and male patients. In the same way, to calculate moderate coronary artery stenosis(50%~75% stenosis degree), severe and occlusion(76%~100% stenosis degree) in different gender. And to analyse whether there are differences in the diagnosis value of 64-DSCTCA in female and male patients with chi-square statistics. The data were conducted using statistical software Data Processing SPSS19.0,taking P<0.05 for the difference was statistically significant.Results:Unqualified Images of coronary artery were excluded, image quality have reached the diagnostic criteria, a total of 1257 segments can be evaluated both CAG and 64-DSCTCA with men accounting for 636 segments and women for 621 segments.1. The stenosis degree≥50% The CAG as the gold standard, the sensitivity, specificity, positive predictive value and negative predictive value of 64-DSCTCA in female with CAD(stenosis≥50%) are 72.1%,90.8%,69.6% and 91.8%(by segment),respectively. In male they are 80.7%, 93.5%, 80.2% and 93.7%, respectively. The sensitivity, specificity, and negative predictive value were no significance in statistics in different gender(P>0.05),but the difference of positive predictive value was statistically significant(P<0.05), which is positive predictive value of 64-DSCTCA in female with CAD lower than male.2. The stenosis degree of 50%~75% The CAG as the gold standard, the sensitivity, specificity, positive predictive value and negative predictive value of 64-DSCTCA in female with the coronary artery stenosis of 50%~75% are 60.3%,93.9%,50.7% and 95.8%(by segment),respectively. In male they are 69.4%,92.0%,47.1% and 96.7%,respectively. With the moderate stenosis of coronary artery, the sensitivity, specificity, positive predictive value and negative predictive value were no significance in statistics in different gender(P>0.05).3. The stenosis degree of 76%~100% The CAG as the gold standard, the sensitivity, specificity, positive predictive value and negative predictive value of 64-DSCTCA in female with the coronary artery stenosis of 76%~100% are 76.0%,95.8%,70.1% and 96.8%,respectively,on a per-segment basis. In male they are 80.0%,97.8%,84.2% and 97.1%,respectively.The sensitivity, specificity, and negative predictive value were no significance in statistics in different gender(P>0.05),but the difference of positive predictive value was statistically significant(P < 0.05), which is positive predictive value of 64-DSCTCA in female with severe stenosis and occlusion of coronary artery lower than male.Conclusion:1.In the evaluation on coronary heart disease or coronary artery moderate and severe stenosis, the negative predictive value of 64-DSCTCA reaches above 90%, and no difference between male and female. For patients with suspected coronary artery disease and symptoms are not typical, the result of 64-DSCTCA is negative, we mostly can exclude coronary heart disease.64-DSCTCA can be regarded as a good method to exclude CAD, and the patients can avoid invasive coronary angiography examination.2.On the stenosis degree of 50%~75%, which is coronary borderline lesions, the sensitivity and positive predictive value of 64-DSCTCA is significantly lower both male and female patients, and the diagnostic performance of 64-DSCTCA is limited, especially coronary artery stenosis can be further accurately quantified.3.There is significant difference to use 64-DSCTCA to diagnose CAD(the stenosis degree≥50%) and severe stenosis and occlusion of coronary artery(the stenosis degree of 76%~100%)in gender, the positive predictive value is lower in female than in male. For female patients with typical angina pectoris, we can conjecture that lesions of coronary artery is over 50%, it is not appropriate to apply for 64-DSCTCA.