Author + information
- Received December 11, 2018
- Revision received May 28, 2019
- Accepted May 30, 2019
- Published online August 14, 2019.
- Daniele Andreini, MD, PhDa,b,∗ (, )
- Saima Mushtaq, MDa,
- Gianluca Pontone, MD, PhDa,
- Edoardo Conte, MDa,
- Carlos Collet, MDc,
- Jeroen Sonck, MDc,
- Andrea D’Errico, MDb,
- Luca Di Odoardo, MDb,
- Marco Guglielmo, MDa,
- Andrea Baggiano, MDa,
- Daniela Trabattoni, MDa,
- Paolo Ravagnani, MDa,
- Piero Montorsi, MDa,
- Giovanni Teruzzi, MDa,
- Paolo Olivares, MDa,
- Franco Fabbiocchi, MDa,
- Stefano De Martini, MDa,
- Giuseppe Calligaris, MDa,
- Andrea Annoni, MDa,
- Maria Elisabetta Mancini, MDa,
- Alberto Formenti, MDa,
- Marco Magatelli, MDd,
- Elisa Consiglio, MSa,
- Giuseppe Muscogiuri, MDa,
- Federico Lombardi, MDb,e,
- Cesare Fiorentini, MDa,
- Antonio L. Bartorelli, MDa,f and
- Mauro Pepi, MDa
- aCentro Cardiologico Monzino, IRCCS, Milan, Italy
- bDepartment of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
- cCardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
- dDepartment of Cardiology, University of Brescia, Brescia, Italy
- eDepartment of Cardiology, Fondazione Ospedale Policlinico, IRCCS, Milan, Italy
- fDepartment of Biomedical and Clinical Sciences “Luigi Sacco,” University of Milan, Milan, Italy
- ↵∗Address for correspondence:
Dr. Daniele Andreini, Department of Clinical Sciences and Community Health, Cardiovascular Section, Centro Cardiologico Monzino, University of Milan. Via C. Parea 4, 20138 Milan, Italy.
Objectives The goal of this study was to assess the diagnostic performance of coronary computed tomography angiography (CTA) alone, adenosine-stress myocardial perfusion assessed by computed tomography (CTP) alone, and coronary CTA + CTP by using a 16-cm Z-axis coverage scanner versus invasive coronary angiography (ICA) and fractional flow reserve (FFR) as the clinical standard.
Background Diagnostic performance of coronary CTA for in-stent restenosis detection is still challenging. Recently, CTP showed additional diagnostic power over coronary CTA in patients with suspected coronary artery disease. However, few data are available on CTP performance in patients with previous stent implantation.
Methods Consecutive stable patients with previous coronary stenting referred for ICA were enrolled. All patients underwent stress myocardial CTP and rest CTP + coronary CTA. Invasive FFR was performed during ICA when clinically indicated. The diagnostic rate and diagnostic accuracy of coronary CTA, CTP, and coronary CTA + CTP were evaluated in stent-, territory-, and patient-based analyses.
Results In the 150 enrolled patients (132 men; mean age 65.1 ± 9.1 years), the CTP diagnostic rate was significantly higher than that of coronary CTA in all analyses (territory based [96.7% vs. 91.1%; p < 0.0001] and patient based [96% vs. 68%; p < 0.0001]). When ICA was used as gold standard, CTP diagnostic accuracy was significantly higher than that of coronary CTA in all analyses (territory based [92.1% vs. 85.5%, p < 0.03] and patient based [86.7% vs. 76.7%, p < 0.03]). The concordant coronary CTA + CTP assessment exhibited the highest diagnostic accuracy values versus ICA (95.8% in the territory-based analysis). The diagnostic accuracy of CTP was significantly higher than that of coronary CTA (75% vs. 30.5%; p < 0.001). The radiation exposure of coronary CTA + CTP was 4.15 ± 1.5 mSv.
Conclusions In patients with coronary stents, CTP significantly improved the diagnostic rate and accuracy of coronary CTA alone compared with both ICA and invasive FFR as gold standard.
The study received a grant from General Electric (GE Healthcare); the registration number of the study is R509/16-CCM 536. Dr. Andreini has served on the Speakers Bureau for GE Healthcare; and has received a research grant from GE Healthcare and Bracco (to the institution). Dr. Pontone has served on the Speakers Bureau for GE Healthcare, Bracco, and Medtronic; and has served as a consultant for GE Healthcare. Dr. Collet has received research grants from Heart Flow Inc. and Biosensor. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 11, 2018.
- Revision received May 28, 2019.
- Accepted May 30, 2019.
- 2019 American College of Cardiology Foundation
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