Heart:MSCT和IVUS评估支架内情况一致性良好

　　西班牙一项研究表明，就评估冠脉动脉左主干（LMAC）支架内最小管腔面积（MLA）和最小管腔直径（MLD）而言，多层螺旋CT（MSCT）和血管内超声（IVUS）具有良好的一致性。论文于5月30日在线发表于《心脏》（Heart）。

　　此项其中前瞻性观察性研究共纳入52例LMAC支架植入患者。在随访9至12个月时对所有患者实施MSCT和IVUS检查。主要转归为MSCT和血管内超声MLA和MLD的一致性。

　　结果显示，Passing–Bablok回归分析得出MLA和MLD的β系数分别为0.786和1.250，并且排除比例偏倚。MLA和MLD的α系数分别为-3.588和-1.713，提示MSCT有低估趋势。受试者工作特征（ROC）曲线确认MLA ≤4.7 mm²为MSCT评估支架内再狭窄的最佳阈值。

Multislice CT for assessing in-stent dimensions after left main coronary artery stenting: a comparison with three dimensional intravascular ultrasound

Objective 

To evaluate the agreement between multislice CT (MSCT) and intravascular ultrasound (IVUS) to assess the in-stent lumen diameters and lumen areas of left main coronary artery (LMCA) stents.

Design 

Prospective, observational single centre study.

Setting 

A single tertiary referral centre.

Patients 

Consecutive patients with LMCA stenting excluding patients with atrial fibrillation and chronic renal failure.

Interventions 

MSCT and IVUS imaging at 9–12 months follow-up were performed for all patients.

Main outcome measures 

Agreement between MSCT and IVUS minimum luminal area (MLA) and minimum luminal diameter (MLD). A receiver operating characteristic (ROC) curve was plotted to find the MSCT cut-off point to diagnose binary restenosis equivalent to 6 mm2 by IVUS.

Results 

52 patients were analysed. Passing–Bablok regression analysis obtained a β coefficient of 0.786 (0.586 to 1.071) for MLA and 1.250 (0.936 to 1.667) for MLD, ruling out proportional bias. The α coefficient was −3.588 (−8.686 to −0.178) for MLA and −1.713 (−3.583 to −0.257) for MLD, indicating an underestimation trend of MSCT. The ROC curve identified an MLA ≤4.7 mm2 as the best threshold to assess in-stent restenosis by MSCT.

Conclusions 

Agreement between MSCT and IVUS to assess in-stent MLA and MLD for LMCA stenting is good. An MLA of 4.7 mm2 by MSCT is the best threshold to assess binary restenosis. MSCT imaging can be considered in selected patients to assess LMCA in-stent restenosis.