Assessment of coronary artery stent restenosis by 64-slice multi-detector computed tomography
Key result
Sixty-four-slice MDCT detects in-stent restenosis with ~98% specificity but assesses only ~58% of stents.
- sensitivity 50%
- 95% CI 22-77
- n=64
Why the study?
The feasibility and accuracy of assessing coronary artery stent restenosis using 64-slice multi-detector computed tomography compared to conventional quantitative angiography were investigated.
Does 64-slice MDCT accurately detect in-stent restenosis compared to invasive quantitative coronary angiography in patients with previously implanted coronary stents?
Population
64 consecutive patients with 102 coronary artery stented lesions, mean age 58±10 years
Comparison
64-slice multi-detector computed tomography vs invasive quantitative coronary angiography
Design
Observational study
Authors
Discussion
Loading...
Member takes
Implication
Limited utility for routine ISR assessment with 64-slice MDCT; leaves open its role pending CT advances improving evaluability.
Key Points
- To evaluate the feasibility and diagnostic accuracy of 64-slice multi-detector computed tomography (MDCT) for detecting coronary in-stent restenosis compared with conventional quantitative coronary angiography.
- Examined 64 consecutive patients (mean age 58±10 years) with 102 previously implanted coronary stents (mean stent diameter 3.17±0.38 mm) using 64-slice MDCT.
- Classified stented lesions as evaluable or unevaluable, visually assessed evaluable stents for restenosis (diameter reduction >50%), and compared results with invasive quantitative coronary angiography.
- Only 58% (59/102) of stented lesions were evaluable on MDCT; evaluable stents had significantly larger diameters than unevaluable stents (3.28±0.40 mm vs. 3.03±0.31 mm, P=0.0002).
- Across all stented lesions, MDCT correctly detected 6 of 12 restenoses [sensitivity 50% (95% CI, 22–77%)] and ruled out 51 of 90 restenoses [specificity 57% (95% CI, 46–67%)].
- In evaluable stents, MDCT detected 6 of 7 restenoses and ruled out 51 of 52 restenoses, achieving a sensitivity of 86% (95% CI, 42–99%) and a specificity of 98% (95% CI, 88–100%).
Study Design
Type
Observational (n=64)
Structured PICO
Does 64-slice MDCT accurately detect in-stent restenosis compared to invasive quantitative coronary angiography in patients with previously implanted coronary stents?
P
Population
64 consecutive patients (mean age 58 years) with 102 previously implanted coronary artery stents.
E
Exposure
64-slice multi-detector computed tomography (MDCT)
C
Comparator
Invasive, quantitative coronary angiography
O
Outcome
Detection of in-stent restenosis (diameter reduction >50%)surrogate
Main Result
Effect estimate: sensitivity 50% (95% CI 22-77)
64-slice MDCT has a low overall evaluability rate for coronary stents, but offers high diagnostic accuracy for in-stent restenosis in the subset of stents that are evaluable.
Limitations
- The rate of assessable stents is low
- Stent type and diameter influence evaluability concerning in-stent restenosis by MDCT
- Low rate of assessable stents
- Stent type and diameter influence evaluability
Cite This Study
Rixe et al. (2006) conducted an observational in previously implanted coronary artery stents (n=64). 64-slice multi-detector computed tomography (MDCT) vs. invasive, quantitative coronary angiography was evaluated on detection of in-stent restenosis (diameter reduction >50%) (sensitivity 50%, 95% CI 22-77). 64-slice MDCT had a low rate of assessable stents (58%), but in evaluable stents, it detected in-stent restenosis with 86% sensitivity (95% CI 42-99%) and 98% specificity (95% CI 88-100%).