Document Detail


Assessment of in-stent restenosis using 64-MDCT: analysis of the CORE-64 Multicenter International Trial.
MedLine Citation:
PMID:  20028909     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Evaluations of stents by MDCT from studies performed at single centers have yielded variable results with a high proportion of unassessable stents. The purpose of this study was to evaluate the accuracy of 64-MDCT angiography (MDCTA) in identifying in-stent restenosis in a multicenter trial.
MATERIALS AND METHODS: The Coronary Evaluation Using Multidetector Spiral Computed Tomography Angiography Using 64 Detectors (CORE-64) Multicenter Trial and Registry evaluated the accuracy of 64-MDCTA in assessing 405 patients referred for coronary angiography. A total of 75 stents in 52 patients were assessed: 48 of 75 stents (64%) in 36 of 52 patients (69%) could be evaluated. The prevalence of in-stent restenosis by quantitative coronary angiography (QCA) in this subgroup was 23% (17/75). Eighty percent of the stents were <or=3.0 mm in diameter.
RESULTS: The overall sensitivity, specificity, positive predictive value, and negative predictive value to detect 50% in-stent stenosis visually using MDCT compared with QCA was 33.3%, 91.7%, 57.1%, and 80.5%, respectively, with an overall accuracy of 77.1% for the 48 assessable stents. The ability to evaluate stents on MDCTA varied by stent type: Thick-strut stents such as Bx Velocity were assessable in 50% of the cases; Cypher, 62.5% of the cases; and thinner-strut stents such as Taxus, 75% of the cases. We performed quantitative assessment of in-stent contrast attenuation in Hounsfield units and correlated that value with the quantitative percentage of stenosis by QCA. The correlation coefficient between the average attenuation decrease and >or=50% stenosis by QCA was 0.25 (p=0.073). Quantitative assessment failed to improve the accuracy of MDCT over qualitative assessment.
CONCLUSION: The results of our study showed that 64-MDCT has poor ability to detect in-stent restenosis in small-diameter stents. Evaluability and negative predictive value were better in large-diameter stents. Thus, 64-MDCT may be appropriate for stent assessment in only selected patients.
Authors:
Joanna J Wykrzykowska; Armin Arbab-Zadeh; Gustavo Godoy; Julie M Miller; Shezhang Lin; Andrea Vavere; Narinder Paul; Hiroyuki Niinuma; John Hoe; Jeffrey Brinker; Faisal Khosa; Sheryar Sarwar; Joao Lima; Melvin E Clouse
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  AJR. American journal of roentgenology     Volume:  194     ISSN:  1546-3141     ISO Abbreviation:  AJR Am J Roentgenol     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2009-12-23     Completed Date:  2010-01-26     Revised Date:  2012-10-09    
Medline Journal Info:
Nlm Unique ID:  7708173     Medline TA:  AJR Am J Roentgenol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  85-92     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Contrast Media
Coronary Angiography / methods*
Coronary Stenosis / radiography,  therapy*
Female
Graft Occlusion, Vascular / radiography*
Humans
Iopamidol / diagnostic use
Male
Middle Aged
Predictive Value of Tests
Registries
Regression Analysis
Sensitivity and Specificity
Stents*
Tomography, Spiral Computed / methods*
Grant Support
ID/Acronym/Agency:
HO1-HC95162-01/HC/NHLBI NIH HHS; P50 HL083813-05/HL/NHLBI NIH HHS; R01-AG021570-01/AG/NIA NIH HHS; R01-HL66075-01/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Contrast Media; 62883-00-5/Iopamidol
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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