cardioКардиологияKardiologiia0022-90402412-5660Kardiomag10.18087/cardio.2019.12.n565cardio-565Research ArticleАТЕРОСКЛЕРОЗATHEROSCLEROSISКомпьютерная томографическая ангиография коронарных артерий в диагностике стенозирующего коронарного атеросклероза у пациентов в возрасте 70 лет и старшеThe Diagnostic Accuracy of Сoronary Сomputed Tomography Angiography in the Diagnosis of Stable Coronary Artery Disease in Patients Aged 70 Years and OlderКозловС. Г.KozlovS. G.

Москва

Moscow

bestofall@inbox.ruЧерноваО. В.ChernovaO. V.

Москва

Chernova Olga V. – graduate student

Moscow

Glazunova-23@mail.ruВеселоваТ. Н.VeselovaT. N.

Москва

Moscow

tnikveselova@gmail.comТерновойС. К.TernovoyS. K.tnikveselova@gmail.comФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава РоссииРоссияNational Medical Research Center for CardiologyRussian FederationФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России; ФГАОУ ВО Первый Московский государственный медицинский университет им. И. М. Сеченова Минздрава России (Сеченовский Университет)РоссияNational Medical Research Center for Cardiology; Sechenov First Moscow State Medical University (Sechenov University)Russian Federation20191112201959122834Copyright © Kardiomag, 20192019KardiomagKardiomaghttps://cardio.elpub.ru/jour/about/submissions#copyrightNoticehttps://cardio.elpub.ru/jour/article/view/565

Цель. Оценка значимости результатов компьютерной томографической ангиографии (КТА) для диагностики стенозирующего коронарного атеросклероза (СКА) у пациентов в возрасте 70 лет и старше с подозрением на наличие стабильной ишемической болезни сердца (ИБС). Материалы и методы. В исследование включены 390 пациентов в возрасте ≥70 (в среднем 75±5) лет с подозрением на наличие стабильной ИБС, которым в плановом порядке была выполнена инвазивная коронарография (КГ). На первом этапе была оценена частота обнаружения СКА в зависимости от пола и характера боли в грудной клетке и определен контингент больных, у которых проведение КТА с целью диагностики ИБС является целесообразным. На втором этапе были оценены диагностическая значимость и экономическая целесообразность КТА при обследовании 82 пациентов с атипичной стенокардией и неангинозной болью. Результаты. Частота обнаружения СКА у пациентов с типичной стенокардией была очень высокой (>85%), в связи с чем они были исключены из окончательного анализа. У 48 (59%) из 82 пациентов с атипичной стенокардией и неангинозной болью, которым была проведена КТА, имелось стенозирующее поражение коронарных артерий. Данные КТА совпали с результатами КГ во всех случаях. Из 34 пациентов без стенозирующего атеросклероза коронарных артерий данные КТА и КГ совпали в 88% случаев. Чувствительность, специфичность, прогностическая ценность положительного (ПЦ+) результата и прогностическая ценность отрицательного (ПЦ – ) результата КТА в диагностике СКА составили соответственно 100, 88, 92 и 100%. Отношение правдоподобия положительного (ОП+) результата было равно 8,3, отношение правдоподобия отрицательного (ОП – ) результата – 0. Положительный результат увеличивал вероятность наличия СКА с 59 до 86%, отрицательный результат уменьшал вероятность до 0. Выводы. У пациентов в возрасте 70 лет и старше с атипичной стенокардией и неангинозной болью отрицательный результат КТА позволяет исключить СКА. ОП+ результата свидетельствует об умеренно выраженном различии между претестовой и послетестовой вероятностью наличия СКА. В случае невозможности осуществления или неинформативности нагрузочных проб проведение КТА пациентам в возрасте 70 лет и старше с атипичной стенокардией и неангинозной болью позволяет повысить эффективность КГ и уменьшить частоту развития малых осложнений без удорожания стоимости обследования пациентов.

Aim: The purpose of this study was to evaluate the diagnostic accuracy of сoronary сomputed tomography angiography (CCTA) in the diagnosis of stable coronary artery disease (CAD) in patients aged ≥70 years. Materials and methods: The study included 390 patients aged ≥70 years with symptoms suggested stable CAD which underwent elective coronary artery angiography (CAG). Initially the prevalence of angiographically significant CAD was estimated according to the gender and chest pain character, and identifications of patients in whom CCTA was appropriate. After that diagnostic accuracy and сost-efficiency of CCTA in the diagnosis of stable CAD in 82 patients with atypical angina and non-anginal chest pain were evaluated. Results: The prevalence of obstructive CAD in patients with typical angina was very high and they were excluded from the final analysis. Among 82 patients with atypical angina and non-anginal pain which underwent CCTA 48 (59%) patients had obstructive CAD. CСTA data matched with results of CAG in all cases. Among 34 patients that had non-obstructive CAD the results of CCTA and CAG matched in 88% cases. CCTA has sensitivity, specificity, positive predictive value, negative predictive value of 100%, 88%, 92% and 100% respectively. The likelihood ratio for positive result was 8.3, likelihood ratio for negative result was 0.3. Positive result increased post-test probability of obstructive CAD from 42% to 86%, negative result reduced post-test probability of obstructive CAD to 0%. Conclusion: negative CCTA result in patients aged 70 years and older with atypical angina and non-anginal pain allows to exclude the presence of obstructive CAD.  The likelihood ratio for positive result indicates a moderately difference between the pre-test and post-test probability of the presence of obstructive CAD. In patients aged ≥70 years with atypical angina or non-anginal chest pain which have inconclusive results of functional testing or unable undergo functional testing CCTA allows to increase diagnostic yield of CAG and reduce the frequency of minor complications and diagnostic evaluation costs.

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The authors declare that there are no conflicts of interest present.