The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지

Normal coronary CT angiography with subsequent adverse cardiac events

관상동맥 CT 혈관조영술상 정상이었으나 심혈관계 사건이 발생한 2예

  • Lee, Chan-Joo (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Kim, Kwang-Joon (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Oh, Chang-Myung (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Yu, Hee-Tae (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Jang, Ji-Yong (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Choi, Dong-Hoon (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Chang, Hyuk-Jae (Department of Internal Medicine, Yonsei University College of Medicine)
  • 이찬주 (연세대학교 의과대학 내과학교실) ;
  • 김광준 (연세대학교 의과대학 내과학교실) ;
  • 오창명 (연세대학교 의과대학 내과학교실) ;
  • 유희태 (연세대학교 의과대학 내과학교실) ;
  • 장지용 (연세대학교 의과대학 내과학교실) ;
  • 최동훈 (연세대학교 의과대학 내과학교실) ;
  • 장혁재 (연세대학교 의과대학 내과학교실)
  • Received : 2009.11.06
  • Accepted : 2009.11.16
  • Published : 2010.11.01
⟨ Previous Next ⟩

Abstract

Multi-detector row coronary computed tomography (CT) angiography is an emerging noninvasive diagnostic tool for coronary artery disease. Because of the high negative predictive value of the test, coronary CT angiography is useful for ruling out significant coronary artery stenosis in patients with chest pain. Between 2003 and 2009, 2,148 (50%) of 4,337 patients who underwent coronary CT angiography had a normal coronary artery. Of the 2,148 patients, only two (0.09%) experienced cardiovascular events within three months of their index visit. One patient underwent invasive coronary angiography based on a positive exercise test result, while the second underwent invasive coronary angiography due to an episode of chest pain. Coronary angiographic examination of these two patients revealed significant luminal narrowing of the proximal left anterior descending artery; both patients underwent revascularization at the discretion of their physician.

저자들은 관상동맥 CT 혈관조영술상 정상소견이었으나 단기 추적 중 심혈관계 사건이 발생한 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

Keywords

References

  1. Bastarrika G, Lee YS, Ruzsics B, Schoepf UJ. Coronary CT angiography: applications. Radiol Clin North Am 47:91-107, 2009 https://doi.org/10.1016/j.rcl.2008.10.010
  2. Bastarrika G, Thilo C, Headden GF, Zwerner PL, Costello P, Schoepf UJ. Cardiac CT in the assessment of acute chest pain in the emergency department. AJR Am J Roentgenol 193:397-409, 2009 https://doi.org/10.2214/AJR.08.2265
  3. Gaspar T, Halon DA, Lewis BS, Adawi S, Schliamser JE, Rubinshtein R, Flugelman MY, Peled N. Diagnosis of coronary in-stent restenosis with multidetector row spiral computed tomography. J Am Coll Cardiol 46:1573-1579, 2005 https://doi.org/10.1016/j.jacc.2005.07.049
  4. Malagutti P, Nieman K, Meijboom WB, van Mieghem CA, Pugliese F, Cademartiri F, Mollet NR, Boersma E, de Jaegere PP, de Feyter PJ. Use of 64-slice CT in symptomatic patients after coronary bypass surgery: evaluation of grafts and coronary arteries. Eur Heart J 28:1879-1885, 2007 https://doi.org/10.1093/eurheartj/ehl155
  5. Lesser JR, Flygenring B, Knickelbine T, Hara H, Henry J, Kalil A, Pelak K, Lindberg J, Pelzel J, Schwartz RS. Clinical utility of coronary CT angiography: coronary stenosis detection and prognosis in ambulatory patients. Catheter Cardiovasc Interv 69:64-72, 2007 https://doi.org/10.1002/ccd.20904
  6. Jacobs JE, Boxt LM, Desjardins B, Fishman EK, Larson PA, Schoepf J. ACR practice guideline for the performance and interpretation of cardiac computed tomography (CT). J Am Coll Radiol 3:677-685, 2006 https://doi.org/10.1016/j.jacr.2006.06.006
  7. Hamon M, Morello R, Riddell JW. Coronary arteries: diagnostic performance of 16- versus 64-section spiral CT compared with invasive coronary angiography: meta-analysis. Radiology 245:720-731, 2007 https://doi.org/10.1148/radiol.2453061899
  8. Hendel RC, Patel MR, Kramer CM, Poon M, Carr JC, Gerstad NA, Gillam LD, Hodgson JM, Kim RJ, Lesser JR, Martin ET, Messer JV, Redberg RF, Rubin GD, Rumsfeld JS, Taylor AJ, Weigold WG, Woodard PK, Brindis RG, Douglas PS, Peterson ED, Wolk MJ, Allen JM. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology. J Am Coll Cardiol 48:1475-1497, 2006 https://doi.org/10.1016/j.jacc.2006.07.003
  9. Raff GL, Gallagher MJ, O'Neill WW, Goldstein JA. Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. J Am Coll Cardiol 46:552-557, 2005 https://doi.org/10.1016/j.jacc.2005.05.056
  10. Pugliese F, Mollet NR, Runza G, van Mieghem C, Meijboom WB, Malagutti P, Baks T, Krestin GP, deFeyter PJ, Cademartiri F. Diagnostic accuracy of non-invasive 64-slice CT coronary angiography in patients with stable angina pectoris. Eur Radiol 16:575-582, 2006 https://doi.org/10.1007/s00330-005-0041-0
  11. Oudkerk M, Stillman AE, Halliburton SS, Kalender WA, Mohlenkamp S, McCollough CH, Vliegenthart R, Shaw LJ, Stanford W, Taylor AJ, van Ooijen PM, Wexler L, Raggi P. Coronary artery calcium screening: current status and recommendations from the European Society of Cardiac Radiology and North American Society for Cardiovascular Imaging. Eur Radiol 18:2785-2807, 2008 https://doi.org/10.1007/s00330-008-1095-6
  12. Greenland P, LaBree L, Azen SP, Doherty TM, Detrano RC. Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA 291:210-215, 2004 https://doi.org/10.1001/jama.291.2.210
  13. Ong TK, Chin SP, Liew CK, Chan WL, Seyfarth MT, Liew HB, Rapaee A, Fong YY, Ang CK, Sim KH. Accuracy of 64-row multidetector computed tomography in detecting coronary artery disease in 134 symptomatic patients: influence of calcification. Am Heart J 151:1323, e1-6, 2006 https://doi.org/10.1016/j.ahj.2005.12.027
  14. Brodoefel H, Reimann A, Burgstahler C, Schumacher F, Herberts T, Tsiflikas I, Schroeder S, Claussen CD, Kopp AF, Heuschmid M. Noninvasive coronary angiography using 64-slice spiral computed tomography in an unselected patient collective: effect of heart rate, heart rate variability and coronary calcifications on image quality and diagnostic accuracy. Eur J Radiol 66:134-141, 2008 https://doi.org/10.1016/j.ejrad.2007.05.013
  15. Pugliese F, Hunink MG, Gruszczynska K, Alberghina F, Malago R, van Pelt N, Mollet NR, Cademartiri F, Weustink AC, Meijboom WB, Witteman CL, de Feyter PJ, Krestin GP. Learning curve for coronary CT angiography: what constitutes sufficient training? Radiology 251:359-368, 2009 https://doi.org/10.1148/radiol.2512080384
  16. Budoff MJ, Achenbach S, Berman DS, Fayad ZA, Poon M, Taylor AJ, Uretsky BF, Williams KA. Task force 13: training in advanced cardiovascular imaging (computed tomography) endorsed by the American Society of Nuclear Cardiology, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, and Society of Cardiovascular Computed Tomography. J Am Coll Cardiol 51:409-414, 2008 https://doi.org/10.1016/j.jacc.2007.11.021
  17. Hoe JW, Toh KH. A practical guide to reading CT coronary angiograms: how to avoid mistakes when assessing for coronary stenoses. Int J Cardiovasc Imaging 23:617-633, 2007 https://doi.org/10.1007/s10554-006-9173-9
  18. Sato A, Nozato T, Hikita H, Miyazaki S, Takahashi Y, Kuwahara T, Takahashi A, Hiroe M, Aonuma K. Incremental value of combining 64-slice computed tomography angiography with stress nuclear myocardial perfusion imaging to improve noninvasive detection of coronary artery disease. J Nucl Cardiol 17:19-26, 2010 https://doi.org/10.1007/s12350-009-9150-5