Acampa Wanda, Petretta Mario, Florimonte Luigia, Mattera Angela, Cuocolo Alberto
Department of Biomorphological and Functional Sciences, Institute of Biostructures and Bioimaging of the National Council of Research, Naples, Italy.
Am J Cardiol. 2003 Feb 1;91(3):259-63. doi: 10.1016/s0002-9149(02)03151-x.
The long-term prognostic value of single-photon emission computed tomography (SPECT) performed late after percutaneous coronary intervention (PCI) has not been extensively evaluated. Moreover, the role of myocardial ischemia at SPECT in symptom-free patients after PCI is not clear. This study was designed to determine the long-term prognostic value of SPECT in predicting cardiac events after PCI in symptomatic and symptom-free patients. Exercise technetium-99m sestamibi SPECT was performed in 206 patients between 12 and 18 months after PCI. All patients were followed for a mean period of 37 +/- 16 months. Cardiac death, nonfatal myocardial infarction, and late revascularization procedures were considered to be events. Myocardial ischemia at SPECT was detectable in 44 patients. During follow-up, 24 patients experienced events (cardiac death in 4 patients, myocardial infarction in 10, and late revascularization in 10). At univariate analysis, the summed stress score (p <0.05) and summed difference score (p <0.001) were significant predictors of cardiac events. Event-free survival curves showed a higher event rate in patients with than without ischemia (p <0.001). The occurrence of cardiac events was higher in the presence of ischemia at SPECT in symptomatic and symptom-free patients (both p <0.001). The results of this study demonstrate that the extent and severity of myocardial ischemia at exercise SPECT performed between 12 and 18 months after PCI predicts cardiac events during long-term follow-up in symptomatic and symptom-free patients.
经皮冠状动脉介入治疗（PCI）后晚期进行的单光子发射计算机断层扫描（SPECT）的长期预后价值尚未得到广泛评估。此外，PCI后无症状患者中SPECT显示的心肌缺血的作用尚不清楚。本研究旨在确定SPECT对有症状和无症状患者PCI后心脏事件的长期预后价值。对206例患者在PCI后12至18个月进行运动锝-99m甲氧基异丁基异腈SPECT检查。所有患者平均随访37±16个月。心脏死亡、非致死性心肌梗死和晚期血运重建手术被视为事件。44例患者SPECT显示心肌缺血。随访期间，24例患者发生事件（4例心脏死亡，10例心肌梗死，10例晚期血运重建）。单因素分析显示，总应激评分（p<0.05）和总差异评分（p<0.001）是心脏事件的显著预测因素。无事件生存曲线显示，有缺血的患者比无缺血的患者事件发生率更高（p<0.001）。有症状和无症状患者中，SPECT显示有缺血时心脏事件的发生率更高（均p<0.001）。本研究结果表明，PCI后12至18个月进行的运动SPECT显示的心肌缺血程度和严重程度可预测有症状和无症状患者长期随访期间的心脏事件。
