NON-INVASIVE CORONARY ARTERIES ATHEROSCLEROSIS CT-VISUALIZATION: UP-TO-DATE STANDARDS AND OWN CLINICAL EXPERIENCE STUDY

Abstract

Non-invasive coronary arteries (CA) visualization experiences fast progress recently. Existing evidence-based data and trials show that there is a great need in non-invasive technologies able to trustworthy and accurately identify CA high risk atherosclerotic plaques (AP) and provide more insights into atherosclerosis pathophysiology in individual patents, being accurate qualitative and quantitative methods of primary diagnosis and answer to therapeutic intervention indicators in patients with coronary artery (CAD). Until now in Ukraine there were no studies evaluating accuracy of last generation 640-sliced computed tomography coronary angiography (CTCA) in diagnosing of different CAD forms. Objective of the study was to study diagnostic accuracy of CTCA compared to invasive coronary angiography (iCAG) in the patients with different forms of chronic CAD before surgeon revascularization. Materials and methods. From I.2019 to V.2021 we prospectively studied 201 patients with different chronic CAD forms (76.6 % men and 23.4 % women) aged (61.8 ± 9.2) years hospitalized to our center for diagnostic work-up and decision about primary or secondary revascularization (coronary aortic bypass (CABG) or percutaneous (PCI) intervention). All patients underwent planned CTCA and iCAG. Results and conclusions. There were no significant complication duing procedures performed. Totally 2412 coronary segments were visualized and studied. Coronary calcium index (CI) highly significantly correlated with overall burden and severity of atherosclerotic process (r = 0,73, р < 0.0001). CTCA compared to iCAG showed no false-negative results and only 6 (2.99 %) false positive results in cases of insignificant lesions. There was no significant difference in diagnostic accuracy for significant stenoses with very high accuracy for overall vessels lesions quantity and burden (r = 0.95, р < 0.0001) with very high prognostic method accuracy (AUC 0.99; OR >>1000, р < 0.0001), making high multi-sliced CTCA safe and extremely accurate method for qualitative and quantitative diagnosis of atherosclerotic CA lesions absolutely comparable to iCAG, including hemodynamic significance evaluation. Key words: atherosclerosis, atherosclerotic plaque, coronary calcium, coronary arteries disease, computed tomography, coronary angiography, multimodality visualization.