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Additional diagnostic value of ct perfusion over coronary ct angiography in stented patients with suspected in-stent restenosis or coronary artery disease progression: ADVANTAGE study. Preliminary res

Session CT-FFR and CT-Perfusion: a river of knowledge

Speaker Edoardo Conte

Event : ESC Congress 2018

  • Topic : imaging
  • Sub-topic : CT Myocardial Perfusion
  • Session type : Rapid Fire Abstracts

Authors : D Andreini (Milan,IT), S Mushtaq (Milan,IT), E Conte (Milan,IT), E Mancini (Milan,IT), M Magatelli (Milan,IT), M Guglielmo (Milan,IT), A Baggiano (Milan,IT), J Sonck (Brussels,BE), AM Ramada Oliveira (Milan,IT), D Trabattoni (Milan,IT), F Fabbiocchi (Milan,IT), G Pontone (Milan,IT), C Fiorentini (Milan,IT), AL Bartorelli (Milan,IT), M Pepi (Milan,IT)

Authors:
D. Andreini1 , S. Mushtaq2 , E. Conte2 , E. Mancini2 , M. Magatelli2 , M. Guglielmo2 , A. Baggiano2 , J. Sonck3 , A.M. Ramada Oliveira2 , D. Trabattoni2 , F. Fabbiocchi2 , G. Pontone2 , C. Fiorentini2 , A.L. Bartorelli1 , M. Pepi2 , 1University of Milan, Foundation Monzino (IRCCS), Center Cardiology, Dpt of Cardiology - Milan - Italy , 2Cardiology Center Monzino IRCCS - Milan - Italy , 3University Hospital (UZ) Brussels - Brussels - Belgium ,

Citation:
European Heart Journal ( 2018 ) 39 ( Supplement ), 672

Background: Although recent studies demonstrated a significant improvement in the diagnostic performance of coronary CT angiography (CCTA) for the evaluation of in-stent restenosis (ISR), the assessment of patients with coronary stents remains challenging. Aim of the study is to assess the diagnostic performance of CCTA alone, CTP alone and CCTA plus CTP performed with the latest scanner generation that combine a whole-heart coverage with high spatial and temporal resolution, by using invasive coronary angiography (ICA) as standard of reference.

Materials and methods: A cohort of consecutive patients referred for a clinically ICA for suspicion of ISR or progression of native CAD were enrolled. The feasibility of CCTA, CTP and the combined evaluation CCTA plus CTP were calculated in a stent-based, territory-based and patient-based analysis. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of CCTA, CTP, combined evaluation CCTA-CTP (the whole CT examination was considered as positive when CCTA indicated a >50% stenosis in native segment or >50% ISR and/or CTP indicated a perfusion defect) and concordant evaluation CCTA-CTP (when CCTA documented >50% stenosis or ISR and CTP a perfusion defect in the same region or both tests were negative) vs. ICA in a stent-based, territory-based and patient-based analysis. Radiation exposure of CCTA, CTP and ICA was recorded.

Results: Sixty-nine patients were enrolled (58 male, mean age 63±9 years-old). CTP feasibility was significantly higher than CCTA feasibility in a stent-based, territory-based and patient based analysis (97%vs.86%, p<0.001; 97%vs.91%, p=0.002; 95%vs.65%, p<0.001, respectively). The feasibility of the combined evaluation CCTA-CTP was significantly higher than CCTA feasibility in a stent-based, territory-based and patient based analysis (97% vs. 86%, p=0.0001; 100% vs.91%, p<0.001; 100%vs.65%, p<0.0001, respectively). The diagnostic accuracy of CCTA was 78%, 81% and 78%, in a stent-based, territory-based and patient based analysis, respectively; the diagnostic accuracy of CTP was 90%, 92% and 84%, respectively; the diagnostic accuracy of combined CCTA-CTP was 84%, 88% and 83%, respectively; the diagnostic accuracy of concordant CCTA-CTP was 95%, 97% and 96%, respectively. The diagnostic accuracy of CTP was higher than that of CCTA in a stent-based (p=0.001) and territory-based (p<0.001) analysis. The diagnostic accuracy of concordant CCTA-CTP was higher than that of CCTA and CTP in a patient-based analysis (p=0.007 and p=0.04, respectively). The mean effective dose of the entire CT assessment (CCTA-CTP) was 3.89±1.35 mSv.

Conclusion: The CTP assessment appears as more feasible and more accurate than the anatomical evaluation alone by CCTA in patients with coronary stents. When results of CCTA and CTP are concordant, the diagnostic accuracy of the combined evaluation is very high and associated with low radiation exposure.

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