학술대회 안내 사전등록 안내 초록등록 안내 초록등록/관리 숙박및교통 안내


мȸ ǥ ʷ

ǥ : ȣ - 500490   126 
Spiral Coronary CT Angiography as a Screening Tool in Asymptomatic Population: a Troubleshooter or Troublemaker?
서울대학교 의과대학 내과학 교실, 서울대학교병원 순환기 내과¹ 분당서울대학교병원 심장센터² 분당서울대학교병원 진단방사선과³
최의근¹, 장성아¹ 전은주³ 최상일³ 장혁재² 조영석² 정우영² 채인호² 최동주²
OBJECTIVES: Spiral coronary CT angiography (CCTA) showed promise results for noninvasive detection of coronary stenosis in various populations. However, there is a paucity of information on the role of CCTA in asymptomatic subsets. We evaluated the prevalence of occult coronary artery disease (CAD) on CCTA and its impact on the management in asymptomatic population.
METHODS: We enrolled 1,187 asymptomatic consecutive subjects (mean age 49.4 ± 9.7 years, 63% men) who underwent CCTA (64-slice MDCT) as a part of health check-up. End points included (1) identification of subjects with CAD on CCTA and coronary angiography (CAG) and (2) performance of any second diagnostic test (ST) within 90 days of index CCTA.
RESULTS: Among 257 (21.7%) subjects who had abnormal CCTA cardiac findings, 72 (6.1%) subjects had significant coronary artery stenosis. A ST after CCTA was performed in 68 (5.7%) patients (in 36, CAG; in 39, myocardial perfusion scintigraphy, followed by CAG in 7). Of the 36 patients who underwent CAG, CAD was confirmed in 25 patients and 15 of them had undergone revascularization therapy. The most powerful predictor of referral to ST was the severity of stenosis on CCTA. Dividing the whole population based on National Cholesterol Education Program guidelines, incidence of significant stenosis on CCTA and referral rates to ST were significantly higher in high-risk group compared to moderate- and low-risk group (significant stenosis: 15.3% vs. 8.0% vs. 3.1%; secondary test: 14.6% vs. 8.6% vs. 2.4%, all p<0.001, respectively). Comparing with age, sex-matched control not evaluated with CCTA, the referral rates to ST of CCTA group was significantly higher in high- and moderate-risk subjects (between high-risk groups, 14.6% vs 4.6%; between moderate-risk groups, 8.6% vs 3.8%; all p<0.05).
CONCLUSIONS: In asymptomatic population, the prevalence of CAD on CCTA was 6.1%. Even in asymptomatic population, especially those with high- and moderate-risk group, CCTA had a significant impact on screening and managing occult CAD. However, CCTA had no impact on patient management and might be harmful considering radiation hazard in those with low-risk.


[ư]