Evaluation of the Diagnostic Accuracy of Coronary Computed Tomographic Angiography Introduction: Coronary computed tomographic angiography (CCTA) has been widely accepted as a non-invasive diagnostic tool for coronary artery disease (CAD). The objective of this study was to evaluate the diagnostic performance of CCTA and its influence on modification of percutaneous revascularization strategies. Method: The study included two groups of patients: a main group (MG), including 100 patients screened with a suspect of severe CAD by CCTA and indication for coronary cineangiography (CINE), and a control group (CG) for comparison, including 100 patients selected during the same period, with indication for CINE according to clinical criteria or by positive functional tests. We evaluated the performance of CCTA for the diagnosis of lesions > 50% in coronary segments, arteries and patients and the revascularization strategies adopted. Results: The sensitivity, specificity and positive and negative predictive values of CCTA were 86%, 95%, 71% and 100% for the coronary segments, 91%, 92%, 80% and 100% for the coronary arteries and 100%, 90%, 100% and 100% for patients, respectively. In the MG, percutaneous coronary intervention (PCI) was performed in 90% of the patients, whereas in the CG, percutaneous coronary intervention was performed in 43% of the patients (P = 0.01). Conclusion: CCTA had a high diagnostic performance in detecting CAD and allowed ad hoc PCI to be performed in 90% of the patients. This strategy, however, must await randomized studies to confirm these results.

RESUMOIntrodução: Os idosos representam significativa parcela da população em nosso País e a população com idade > 90 anos triplicou nas últimas três décadas. Este estudo retrospectivo teve como objetivo analisar os resultados da intervenção percutânea em pacientes nonagenários. Método: No total, foram avaliados, retrospectivamente, 31 pacientes nonagenários (G1), submetidos a tratamento coronário percutâneo, tratados entre janeiro de 1995 e janeiro de 2009. Esses pacientes foram comparados a outros 6.222 pacientes com idade < 80 anos (G2), tratados nesse mesmo período. Foram avaliadas as características clínicas, angiográficas e do procedimento, assim como os eventos cardíacos adversos maiores (ECAM) iniciais e tardios (óbito, acidente vascular cerebral, infarto do miocárdio, isquemia recorrente). Resultados: Os pacientes nonagenários apresentaram maior prevalência de diabetes, angina instável, comorbidades crônicas, doença coronária triarterial e fração de ejeção do ventrículo esquerdo < 50%. O sucesso do procedimento diferiu entre os dois grupos (87% vs. 95,1%; P = 0,049), assim como a incidência hospitalar de óbito (6,4% vs. 0,3%; P = 0,022) e de infarto agudo do miocárdio (6,4% vs. 3,6%; P = 0,035). Na evolução tardia, ocorreram diferenças significativas na sobrevivência livre de ECAM (68% vs. 91%; P < 0,001). Fração de ejeção do ventrículo esquerdo < 50% (RR 1,08, IC 0,39-2,99; P = 0,022), mais de dois vasos coroná-rios com lesão > 50% (RR 1,82, IC 1,04-3,19; P = 0,011), lesão do tronco de coronária esquerda (RR 2,98, IC 0,97-9,17; P = 0,001), presença de angina instável (RR 2,48, IC 0,97-9,17; P = 0,0013) e presença de diabetes (RR 2,35, IC 1,21-4,55; P = 0,0015) foram as variáveis preditoras de ECAM. Conclusão: Os pacientes nonagenários demonstraram maior incidência de eventos cardiovasculares comparativamente aos pacientes mais jovens. No entanto, quando a técnica é factível e o paciente se encontra em condições ABSTRACT Percutaneous Coronary Intervention in Ninety-Year-Old PatientsBackground: Elderly people represent a significant part of the Brazilian population and the population > 90 years has tripled in the past three decades. This retrospective study was aimed at analyzing the results of percutaneous coronary intervention in ninety-year-old patients. Method: Overall, 31 ninety-year-old patients (G1) undergoing percutaneous coronary treatment from January 1995 to January 2009 were retrospectively evaluated. These patients were compared to 6,222 patients < 80 years of age (G2), treated within the same period. Clinical, angiographic and procedure characteristics were assessed as well as early and late major adverse cardiovascular events (MACE) (death, stroke, myocardial infarction, recurrent ischemia). Results: Ninety-yearold patients had a greater prevalence of diabetes, unstable angina, chronic comorbidities, three vessel coronary disease and left ventricular ejection fraction < 50%. Procedure success was different between both groups (87% vs. 95.1%; P = 0.049), as well as the incidence of in-hospi...

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