Zerahn B, Jensen B V, Nielsen K D, Møller S
Department of Clinical Physiology, Herlev University Hospital, Copenhagen, Denmark.
J Nucl Cardiol. 2000 Nov-Dec;7(6):616-22. doi: 10.1067/mnc.2000.109028.
Myocardial perfusion imaging (MPI) with technetium-99m-labeled sestamibi and exercise electrocardiography (EECG) are widely used for risk stratification of patients with known or suspected coronary artery disease (CAD). However, no large-scale studies have addressed the prognostic power of the combined information from these diagnostic tools.
We studied 697 consecutive patients who underwent a 2-day Tc-99m sestamibi cardiac perfusion imaging protocol. The EECG was performed on a bicycle ergometer by symptom-limited exercise. Causes of death were obtained from death certificates. Univariate survival analyses were performed with a Kaplan-Meier estimate and a corresponding log-rank test. A multivariate Cox proportional hazards model was applied to test for potential predictor covariates obtained from hospital records. The predominant risk factors of cardiac death were fixed perfusion defects (relative risk, 2.55; range, 1.43 to 4.55) and an impaired circulatory exercise response (relative risk, 3.26; range, 1.74 to 6.08). The major prognostic information of MPI was the ability to detect patients with a definitively low risk. Patients with impaired circulatory response to exercise test and fixed perfusion defects were at a very high risk.
The combined results of MPI and EECG provide substantial information on the long-term risk of cardiac death in patients with suspected CAD.
锝-99m标记的 sestamibi 心肌灌注显像（MPI）和运动心电图（EECG）广泛用于已知或疑似冠心病（CAD）患者的危险分层。然而，尚无大规模研究探讨这些诊断工具联合信息的预后价值。
我们研究了697例连续接受为期2天的锝-99m sestamibi 心脏灌注显像方案的患者。EECG 通过症状限制运动在自行车测力计上进行。死亡原因从死亡证明中获取。采用 Kaplan-Meier 估计和相应的对数秩检验进行单因素生存分析。应用多变量 Cox 比例风险模型检验从医院记录中获得的潜在预测协变量。心脏死亡的主要危险因素是固定灌注缺损（相对风险，2.55；范围，1.43至4.55）和循环运动反应受损（相对风险，3.26；范围，1.74至6.08）。MPI 的主要预后信息是能够检测出绝对低风险的患者。运动试验循环反应受损且有固定灌注缺损的患者风险非常高。
MPI 和 EECG 的联合结果为疑似 CAD 患者心脏死亡的长期风险提供了大量信息。
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