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. 2021 Feb 1;7(2):e06075.
doi: 10.1016/j.heliyon.2021.e06075. eCollection 2021 Feb.

Reliability of coronary computed tomography angiography in acute coronary syndrome in an emergency setting

Sergey Ternovoy  1   2 , Dmitry Ustyuzhanin  2 , Merab Shariya  1   2 , Maria Shabanova  2 , Svetlana Gaman  2 , Natalya Serova  1 , Vsevolod Mironov  2 , Irina Merkulova  2 , Anna Rienmueller  3 , Elias Laurin Meyer  4 , Theresa Rienmueler  5
Affiliations

Reliability of coronary computed tomography angiography in acute coronary syndrome in an emergency setting

Sergey Ternovoy et al. Heliyon. .

Abstract

Background: Cardiovascular computed tomography (cardiovascular CT) is currently used as a fast non-invasive method for the visualization of coronary plaques and walls and the assessment of lumen stenosis severity. Previous studies demonstrated the high negative predictive value of CT for the exclusion of coronary lumen stenoses. In this study we hypothesize that coronary CT angiography (CTA) represents a reliable method as diagnostic procedure in acute coronary syndrome (ACS) even in emergency settings.

Methods: 36 patients (51 lesions) with ACS who underwent cardiovascular CT, intravascular ultrasound (IVUS) and invasive coronary angiography (ICA) within 48 h were included. The percentage of coronary stenoses were measured and compared by three methods. Influence of available predictors that can potentially affect the measurement results was assessed.

Results: Cardiac CTA provided comparable results to IVUS (mean difference -0.45%, PPV: 98%, NPV: 75%). ICA tends to estimate lower stenoses degrees than cardiac CTA and IVUS (mean difference 13.19% and 13.64%, respectively). The final diagnosis and positive remodeling did not lead to any significant influence on measurements.

Conclusions: The cardiovascular CT results show that even in emergency settings it is possible to identify morphological changes as sequels of coronary artery sclerosis with comparable results to the reference method IVUS. Deviations of IVUS and cardiovascular CT from ICA are comparable and can to a large extent be explained by differences in the measurement technique.

Keywords: Acute coronary syndrome; Coronary angiography; Coronary atherosclerosis; Coronary computed tomography; Coronary stenosis; Intravascular ultrasound.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Long-axis view of the LAD on a CT reformatted image (a), plaque extent (blue), maximum stenosis location (red), reference post-stenotic site (green). Corresponding ICA image (b) and enlarged angiogram (c) were used for minimal diameter at the lesion site (yellow) and reference post-stenotic diameter (purple) measurements. Minimal cross-sectional luminal area of the vessel determined by CT (e, blue) including minimal (red) and maximal (green) lumen diameter and IVUS (f, red line). Luminal area at the reference sites calculated using CT (d, blue) and IVUS (g, red).
Figure 2
Figure 2
Classification of stenoses according to recommended quantitative stenosis grading by method.
Figure 3
Figure 3
Bland-Altman plot of CT vs. IVUS. Figure 3–5: Black data points represent the first measurements of patientes, red data points represent the second measurements of patients and green data points represent the third measurements of patients. The blue line represents the mean difference between the two measuring techniques, while the dashed blue lines represent the 95 percent confidence interval for the mean difference. The purple lines represent the mean difference ± the standard deviation of the difference. The grey line marks the fitted linear mixed model regression line.
Figure 4
Figure 4
Bland-Altman plot of CT vs. ICA (explanation see Figure 3).
Figure 5
Figure 5
Bland-Altman plot of ICA vs. IVUS (Explanation see Figure 3).
See this image and copyright information in PMC

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