The Effect of Percutaneous Coronary Revascularisation on Plasma N- terminal Pro-B-type Natriuretic Peptide Levels in Stable Coronary Artery Disease

Journal of Medical Sciences 2013;16(Suppl 1): 1 Comparison of Gadolinium Enhanced Coronary CT Angiography with Conventional Invasive Coronary Angiography in Assessment of Coronary Artery Disease Wasim Ahmed, Khurshid Iqbal Department of Cardiology, Sher-i-Kashmir Institute of Medical Sciences, Soura, J&K, India BACKGROUND: Invasive Coronary Angiography (ICA), though Gold Standard, for assessment of CAD, has inherent risks of an invasive procedure including that of death. Additionally use of Iodinated contrasts in ICA and Coronary CT Angiography is frequently contraindicated due to renal toxicity and hypersensitivity reactions. Hence there is a need to study safer contrast agents in Non-invasive modalities of assessment of CAD. OBJECTIVES: To assess the feasibility of Gd-enhanced 64-slice cardiac CT (CCT) for the diagnosis of obstructive coronary artery disease in comparison to ICA STUDY DESIGN : Hospital Based Prospective Comparative Study METHODS: 25 patients of CAD were selected, who after informed consent, agreed to undergo Gadolinium Enhanced Coronary CT Angiography and Invasive Coronary Angiography. Patients who had previously undergone Revascularisation or those who had Creatinine Clearance less than 30 ml/min were excluded. Creatinine Clearance was measured before and 48 hours after Gd-Enhanced CTA. Analyses was done by comparing coronary segments with ≥ 50% stenoses detected by ICA versus detection of the same by Gd-Enhanced CTA. RESULTS : Mean age of patients was 53.52 years (range 4170 years). Total number of coronary segments evaluated by ICA was 379 of which 57 showed ≥ 50% stenoses. Gd-Enhanced CTA detected 47 of these lesions. In comparison to ICA, on Per-segment basis, GdEnhanced CTA showed Sensitivity of 82.46%, Specificity of 97.50%, PPV of 85.45% and NPV of 96.95%.Weighted Kappa value was 1, suggestive of strong agreement between the two modalities, excluding agreement by chance. No adverse effects occurred after Gadolinium . CONCLUSIONS : Gadolinium Enhanced Coronary CT angiography is safer alternative for assessment of CAD in patients who have a contraindication for ICA or Iodinated Contrasts.