Dual-Source Computed Tomography has a High Negative Predictive Value in the Evaluation of Restenosis after the Left Main Coronary Artery Stenting
1University Hospital Motol, Prague, Czech Republic; 2Department of Imaging Methods, Charles University, 2nd Faculty of Medicine, Prague, Czech Republic
P. Bradacova1, D. Zemanek1, T. Adla2, J. Veselka1
Background: Restenosis of the left main coronary artery (LMCA) after previous stenting is potentially associated with the fatal myocardial infarction and/or sudden cardiac death. Therefore, it was widely accepted to perform repeat coronary angiography (CAG) after the intervention to rule out a significant LMCA restenosis. The aim of this study was to determine whether CAG and dual-source computed tomography (DSCT) are accurate methods in the evaluation of the LMCA after PCI with stent implantation.
Methods: Thirty-two consecutive patients (56% males, 68 กพ 13 years) were prospectively enrolled for follow-up coronary angiography, intravascular ultrasound (IVUS) and DSCT examinations after LMCA stenting (twice during 9-month follow-up). Twenty-five patients were treated with DES and 7 patients with BMS. Restenosis was defined by CAG as > 50% of luminal diameter, by DSCT and IVUS minimal luminal area (MLA) as < 6mm2. IVUS was considered the golden standard in the evaluation of LMCA.
Results: Thirty-nine complete examinations were performed. There were no significant complications during all the examinations. We found 2, 8 and 1 significant restenoses according to CAG, MSCT and IVUS, respectively. Positive predictive values according to CAG and DSCT were 50% and 12,5%, by contrast to negative predictive values for both methods were 100%.
Conclusion: These results suggest that all used methods are safe. Positive predictive value of CAG and mainly DSCT seems to be limited. On the other hand, negative predictive value of CAG and DSCT is closed to 100%. Thus, DSCT is a useful, non-invasive method in the evaluation of the post-PCI restenosis of LMCA. However, finding of restenosis of any significance should be re-evaluated by IVUS.
