The Korean Journal of Medicine

  • 제87권2호
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  • Pages.165-172
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  • 2014
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  • 1738-9364(pISSN)
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  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
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관상동맥 컴퓨터 단층 촬영술과 운동부하 심전도 검사의 실제임상에서의 검사 정확도 비교

Comparison of Computed Tomography Coronary Angiography and Exercise ECG Test for Diagnostic Accuracy in Real-World Practice

  • 윤성은 (경상대학교 의학전문대학원 내과학교실 순환기내과) ;
  • 강영란 (경상대학교 의학전문대학원 내과학교실 순환기내과) ;
  • 김계환 (경상대학교 의학전문대학원 내과학교실 순환기내과) ;
  • 최영민 (경상대학교 의학전문대학원 내과학교실 순환기내과) ;
  • 최정우 (경상대학교 의학전문대학원 내과학교실 순환기내과) ;
  • 고진신 (경상대학교 의학전문대학원 내과학교실 순환기내과) ;
  • 박정랑 (경상대학교 의학전문대학원 내과학교실 순환기내과) ;
  • 박용휘 (경상대학교 의학전문대학원 내과학교실 순환기내과) ;
  • 황석재 (경상대학교 의학전문대학원 내과학교실 순환기내과) ;
  • 정영훈 (경상대학교 의학전문대학원 내과학교실 순환기내과) ;
  • 곽충환 (경상대학교 의학전문대학원 내과학교실 순환기내과) ;
  • 최호철 (경상대학교 의학전문대학원 영상진단학교실) ;
  • 전경녀 (경상대학교 의학전문대학원 영상진단학교실) ;
  • 황진용 (경상대학교 의학전문대학원 내과학교실 순환기내과)
  • Yun, Seongeun (Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine) ;
  • Kang, Young Ran (Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine) ;
  • Kim, Kyehwan (Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine) ;
  • Choi, Young Min (Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine) ;
  • Choi, Jungwoo (Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine) ;
  • Koh, Jin-Sin (Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine) ;
  • Park, Jeong Rang (Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine) ;
  • Park, Yongwhi (Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine) ;
  • Hwang, Seok-Jae (Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine) ;
  • Jung, Young Hoon (Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine) ;
  • Kwak, Choong Hwan (Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine) ;
  • Choi, Hocheol (Departments of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine) ;
  • Jeon, Kyung Nyeo (Departments of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine) ;
  • Hwang, Jin-Yong (Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine)
  • 투고 : 2014.01.07
  • 심사 : 2014.05.03
  • 발행 : 2014.08.01
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 운동부하 심전도 검사(XECG)와 관상동맥 컴퓨터 단층 촬영술(CTCA)은 현재 임상에서 관상동맥 질환의 초기 진단법으로 널리 사용하고 있다. 본 연구는 CTCA와 XECG를 동시에 시행한 환자에서 각 검사의 결과에 따른 고식적 관상동맥 조영술(CCA) 및 재관류시술(RT)의 시행률을 관찰하였고 CCA가 진행된 환자에서 각 검사의 진단능을 비교 분석하여 선별 검사에서 각 검사의 역할과 제한점을 비교하고자 하였다. 방법: 2006년 1월부터 20010년 3월까지 경상대학교병원 외래에서 관상동맥 질환을 평가하기 위해 CTCA와 XECG 검사를 같이 시행한 환자 598명의 임상자료들을 후향적으로 분석하였다 결과: 전체 589명 중 107명(19%)에서 보다 정확한 검사 및 RT를 위해 CCA가 진행되었으며 77명(12.8%) 환자에서 한 가지 이상의 혈관에서 의미 있는 협착(${\geq}50%$)이 발견되었고, 65명(11%)의 환자에서 RT이 시행되었다. CTCA에서 의미 있는 협착(${\geq}50%$)을 보인 120명에서는 RT/CCA가 58 (48%)/75 (62%)명에서 시행되었지만, XECG에서 양성을 보인 115명 중 RT/CCA 23 (20%)/41 (35%)명에서 시행되었다(p < 0.05). 정상 CTCA를 보인 302명 중에는 RT/CCA가 1 (0.8%)/6 (5%)명에서 진행된 반면, XECG 음성이었던 413명 중 RT/CCA가 27 (6.5%)/51 (12%)명에서 진행되었다(p < 0.05). XECG에서 진단이 불가능한 환자가 CTCA보다 많았다(11.7% vs. 5%, p < 0.05). CCA로 진행되었던 107명에서 의미 있는 관상동맥협착(${\geq}50%$)의 CTCA와 XECG의 민감도 89.9%, 50.0%, 특이도 74.0%, 67.9%, 양성예측도 90.6%, 78.0% 및 음성예측도 71.4%, 37.3%로 CTCA의 진단율이 더 우수하였다. CCA와 CTCA진단의 일치율은 0.62로 통계적인 의미가 있었으나(p < 0.001), CCA와 XECG의 일치율은 0.145로 통계적으로 유의하지 않았다(p = 0.113). 결론: 비교적 적은 위험도를 가진 환자에서 관상동맥 질환의 선별 검사로 CTCA의 결과를 XECG보다 더 신뢰하여 임상경로를 결정하고 있었으며 실제 진단율이 CTCA가 XECG보다 우수하였다.

Background/Aims: The exercise ECG test (XECG) and computed tomography coronary angiography (CTCA) have been used widely in initial evaluations of coronary artery disease (CAD) in real-world practice. In this study, we compared the diagnostic power of CTCA and XECG, based on conventional coronary angiography (CCA). Methods: We enrolled 589 consecutive patients retrospectively who had been examined with both XECG and CTCA for the evaluation of CAD in outpatient clinics. Significant stenosis was defined as more than 50% diameter stenosis. Triage to CCA and/or revascularization treatment (RT) by the results of XECG and CTCA and the diagnostic accuracy of both exams, based on CCA, were investigated. Results: In the 589 patients, 107 (19%) were triaged to CCA for further evaluation; in 77 (12.8%) significant stenosis was detected on CCA. Also, 65 (11%) patients underwent RT. In the CTCA results, 120 patients had significant stenosis. Of them, 58 (48%) and 75 (62%) patients were triaged to RT and CCA, respectively. Based on the XECG, 115 positive patients were triaged to RT and CCA (23 [20%]/41 [35%]). Among 107 patients with CCA, the sensitivity, specificity, positive predictive value, and negative predictive value for significant stenosis on CCA of CTCA were 89.9%, 74.0%, 90.6%, and 71.4%, respectively, and those of XECG were 50.0, 67.9, 78.0, and 37.3, respectively. The kappa value of CCA and CTCA was 0.62 (p < 0.001) and that of CCA and XECG was 0.145 (p = 0.113). Conclusions: In real-world practice, CCA was decided on more frequently, based on CTCA. CTCA showed better diagnostic accuracy than XECG.

키워드

참고문헌

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피인용 문헌

  1. Comparison of the Diagnostic Power of Computed Tomography Coronary Angiography and Exercise Electrocardiography as a First Screening Test in Real-World Practice: Is It Ready for Clinical Use? vol.87, pp.2, 2014, https://doi.org/10.3904/kjm.2014.87.2.163