CT血管成像对冠状动脉急性闭塞的诊断价值

目的 评价64层螺旋CT冠状动脉血管成像（CTA）检查对急性心肌梗死恢复期患者冠状动脉病变的诊断价值.方法 选取126例未行急诊PCI的急性心肌梗死恢复期患者,分别行冠状动脉CTA和冠状动脉造影检查,以冠状动脉造影为金标准,评价冠状动脉CTA对急性心肌梗死病变部位及病变部位以远血管情况的诊断价值.结果 冠状动脉CTA诊断急性心肌梗死血管再通的敏感度、特异度、阳性预测值和阴性预测值分别为86.89％、93.85％、92.98％、88.41％,对前降支的诊断能力最强.CTA对梗死相关病变以远血管情况与冠状动脉造影结果相关（r=0.8123,P＜0.01）,且与梗死相关动脉是否再通无关（x2=0.0086,P＞0.05）.结论 冠状动脉CTA能够准确诊断急性心肌梗死动脉再通,初步评价梗死相关病变以远相关血管情况.

Diagnostic value of CTA in acute occlusion of coronary arterys

Objective To review the diagnostic value of CT angiography （CTA） （64-layer spiral CT） in coronary artery diseases in the recovery period of acute myocardial infarction （AMI） patients.Methods Coronary angiography （CAG） was taken as the gold standard,CTA and CAG were compared in 126 cases of recover-term AMI patients who underwent emergency PCI,to evaluate the value of CTA in the diagnosis of AMI lesions and distal vascular lesions.Results The sensitivity of CTA to recanalization in AMI lesions was 86.89%,specificity was 93.85%,positive predictive value was 92.98% and negative predictive value was 88.41%.It was the most valuable diagnostic capabilities of the left anterior descending branch.In spite of the infarct-related artery reperfusion or nonreperfusion,the diagnostic value of CTA in distal vascular lesions were consistent with CAG（r=0.8123,P 〈 0.01）.Conclusion CTA can accurately diagnose coronary artery recanalization in AMI,and provide a primary diagnosis for the infarct-related lesion beyond related vessels.