Objectives The purpose of this study was to assess the diagnostic accuracy of coronary computed tomography angiography (CTA) for bioresorbable vascular scaffold (BVS) evaluation.

Background Coronary CTA has emerged as a noninvasive method to evaluate patients with suspected or established coronary artery disease. The diagnostic accuracy of coronary CTA to evaluate angiographic outcomes after BVS implantation has not been well established.

Methods In the ABSORB II (A Bioresorbable Everolimus-Eluting Scaffold Versus a Metallic Everolimus-Eluting Stent II) study, patients were randomized either to receive treatment with the BVS or everolimus-eluting metallic stent. At the 3-year follow-up, 238 patients (258 lesions) treated with BVS underwent coronary angiography with intravascular ultrasound (IVUS) evaluation and coronary CTA. The diagnostic accuracy of coronary CTA was assessed by the area under the receiver-operating characteristic curve with coronary angiography and IVUS as references.

Results The mean difference in coronary CTA-derived minimal luminal diameter was −0.14 mm (limits of agreement −0.88 to 0.60) with quantitative coronary angiography as reference, whereas the mean difference in minimal lumen area was 0.73 mm² (limits of agreement −1.85 to 3.30) with IVUS as reference. The per-scaffold diagnostic accuracy of coronary CTA for detecting stenosis based on coronary angiography diameter stenosis of ≥50% revealed an area under the receiver-operating characteristic curve of 0.88 (95% confidence interval [CI]: 0.82 to 0.92) with a sensitivity of 80% (95% CI: 28% to 99%) and a specificity of 100% (95% CI: 98% to 100%), whereas diagnostic accuracy based on IVUS minimal lumen area ≤2.5 mm² showed an area under the receiver-operating characteristic curve of 0.83 (95% CI: 0.77 to 0.88) with a sensitivity of 71% (95% CI: 44% to 90%) and a specificity of 82% (95% CI: 75% to 87%). The diagnostic accuracy of coronary CTA was similar to coronary angiography in its ability to identify patients with a significant lesion based on the IVUS criteria (p = 0.75).

Conclusions Coronary CTA has good diagnostic accuracy to detect in-scaffold luminal obstruction and to assess luminal dimensions after BVS implantation. Coronary angiography and coronary CTA yielded similar diagnostic accuracy to identify the presence and severity of obstructive disease. Coronary CTA might become the method of choice for the evaluation of patients treated with BVS.

目的这项研究的目的是评估冠状动脉计算机断层扫描血管造影（CTA）对生物可吸收血管支架（BVS）评估的诊断准确性。

背景技术冠状动脉CTA已成为一种非侵入性方法，用于评估可疑或已确诊的冠状动脉疾病的患者。BVS植入后评估冠状动脉造影结果的冠状动脉CTA的诊断准确性尚未得到很好的确定。

方法在ABSORB II（一种生物可吸收的依维莫司洗脱支架与金属依维莫司洗脱支架II）研究中，患者被随机分配接受BVS或依维莫司洗脱金属支架治疗。在3年的随访中，对BVS治疗的238例患者（258个病灶）进行了冠状动脉造影，并进行了血管内超声（IVUS）评价和冠状动脉CTA。冠状动脉CTA的诊断准确性通过接受者操作特征曲线下的面积评估，并以冠状动脉造影和IVUS作为参考。

结果以定量冠状动脉造影为参考，冠状动脉CTA衍生的最小管腔直径的平均差为-0.14 mm（一致的极限范围为-0.88至0.60），而最小管腔面积的平均差异为0.73 mm ²（一致的极限值为-1.85）至3.30），并以IVUS作为参考。基于≥50％的冠状动脉造影直径狭窄的冠状动脉CTA进行狭窄诊断的每支架诊断准确性显示，在接受者操作特征曲线下的面积为0.88（95％置信区间[CI]：0.82至0.92），具有敏感性80％（95％CI：28％至99％）的特异性和100％（95％CI：98％至100％）的特异性，而基于IVUS最小管腔面积≤2.5mm ^2的诊断准确性在接收器操作特征曲线下显示的面积为0.83（95％CI：0.77至0.88），灵敏度为71％（95％CI：44％至90％），特异性为82％（95％CI：75） ％至87％）。冠状动脉CTA的诊断准确性类似于冠状动脉血管造影，其基于IVUS标准（p = 0.75）识别具有明显病变的患者的能力。

结论冠状动脉CTA对BVS植入后支架内腔梗阻和评估腔体尺寸具有良好的诊断准确性。冠状动脉造影和冠状动脉CTA可以得出类似的诊断准确性，以识别阻塞性疾病的存在和严重程度。冠状动脉CTA可能成为评估BVS治疗患者的首选方法。