Brown K A, Heller G V, Landin R S, Shaw L J, Beller G A, Pasquale M J, Haber S B
Division of Cardiology, University of Vermont, Burlington, VT 05401, USA.
Circulation. 1999 Nov 16;100(20):2060-6. doi: 10.1161/01.cir.100.20.2060.
Because of its brief hemodynamic effects and minor effect on determinants of myocardial oxygen demand, vasodilator stress myocardial perfusion imaging (MPI) can be applied very early after acute myocardial infarction (AMI) for risk stratification, allowing management decisions to be made earlier and thus potentially shortening hospitalization stays, reducing costs, and preventing early cardiac events. This multicenter randomized trial compared the prognostic value of early dipyridamole MPI and standard predischarge submaximal exercise MPI in patients who presented with AMI.
Patients who presented with their first AMI (n=451) were randomized in a 3:1 ratio to undergo either both an early (day 2 to 4) dipyridamole (99m)Tc-sestamibi MPI study and a predischarge (day 6 to 12) submaximal exercise (99m)Tc-sestamibi MPI study or only the predischarge study. Multivariate predictors of in-hospital cardiac events included nuclear imaging summed stress and summed reversibility scores and peak creatine kinase. For postdischarge cardiac events, multivariate predictors in patients undergoing dipyridamole MPI included only the summed stress, reversibility, and rest imaging scores and anterior MI. For a given summed stress score, the interaction of reversibility score further improved the predictive value. Dipyridamole MPI showed better risk stratification than submaximal exercise MPI.
Dipyridamole MPI very early after MI predicts early and late cardiac events, with superior prognostic value compared with submaximal exercise imaging. The extent and severity of the stress defect and reversibility of the defect were the most important predictors of cardiac death and recurrent MI. This technique can allow management decisions to be made earlier with regard to AMI patients and could have important economic impact if applied widely.
由于血管扩张剂负荷心肌灌注成像（MPI）具有短暂的血流动力学效应且对心肌需氧量的决定因素影响较小，故可在急性心肌梗死（AMI）后极早期应用于危险分层，从而能更早地做出管理决策，进而有可能缩短住院时间、降低费用并预防早期心脏事件。这项多中心随机试验比较了早期双嘧达莫MPI和标准出院前次极量运动MPI对AMI患者的预后价值。
首次发生AMI的患者（n = 451）按3:1的比例随机分组，分别接受早期（第2至4天）双嘧达莫（99m）锝 - sestamibi MPI检查和出院前（第6至12天）次极量运动（99m）锝 - sestamibi MPI检查，或仅接受出院前检查。院内心脏事件的多变量预测因素包括核素显像的负荷总分、可逆总分及肌酸激酶峰值。对于出院后心脏事件，接受双嘧达莫MPI检查患者的多变量预测因素仅包括负荷、可逆及静息显像分数和前壁心肌梗死。对于给定的负荷总分，可逆分数的相互作用进一步提高了预测价值。双嘧达莫MPI显示出比次极量运动MPI更好的危险分层。
心肌梗死后极早期的双嘧达莫MPI可预测早期和晚期心脏事件，与次极量运动显像相比具有更高的预后价值。负荷缺损的范围和严重程度以及缺损可逆性是心脏死亡和复发性心肌梗死的最重要预测因素。该技术可使AMI患者更早地做出管理决策，若广泛应用可能产生重要的经济影响。
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