Kapetanopoulos Athanasios, Heller Gary V, Selker Harry P, Ruthazer Robin, Beshansky Joni R, Feldman James A, Griffith John L, Hendel Robert C, Pope J Hector, Spiegler Ethan J, Udelson James E
Hnry Low Heart Center for the Division of Cardiology, Hartford Hospital, Hartford, CT 06102, USA.
J Nucl Cardiol. 2004 Sep-Oct;11(5):570-7. doi: 10.1016/j.nuclcard.2004.05.007.
Resting myocardial perfusion imaging (MPI) improves the triage of patients presenting to the emergency department (ED) with symptoms suggestive of acute cardiac ischemia (ACI). In the ED setting the presence of diabetes mellitus (DM) is a predictor of ACI and hospitalization, but the role of resting MPI in patients with DM is unknown.
A secondary data analysis of a prospective, multicenter, randomized, controlled trial of ED evaluation strategies in patients with symptoms suggestive of ACI and normal or nondiagnostic electrocardiograms was performed. In the main trial 2475 patients were randomized to receive either the usual ED evaluation strategy (n = 1260) or the usual strategy supplemented by results from resting MPI by use of single photon emission computed tomography (SPECT) technetium 99m sestamibi (n = 1215). Patients with diabetes (n = 341) were evaluated separately. Imaging results, final diagnoses, effect on triage, and prognostic value of the SPECT imaging were compared between diabetic and nondiabetic patients. Of the 341 patients with diabetes, 153 (45%) were randomized to the imaging strategy. Patients with DM had higher rates of hospitalization (66% vs 49.6%, P = .0001) and ACI (21.1% vs 12.0%, P < .001) than patients without DM. Among diabetic patients without ACI, the admission rate was 63% in the usual strategy group versus 54% in the imaging strategy group (relative risk [RR] = 0.91 [95% CI, 0.76-1.06]; P = .24). There was no difference in the magnitude of this reduced risk of admission compared with patients without DM (RR = 0.84 [95% CI, 0.77-0.92]; P = .0002 for patients without DM and P = .35 for interaction of diabetes and RR reduction).
Acute resting MPI with Tc-99m sestamibi is associated with improved triage decision making in symptomatic ED patients with diabetes.
静息心肌灌注成像（MPI）有助于对因急性心脏缺血（ACI）症状就诊于急诊科（ED）的患者进行分流。在急诊科环境中，糖尿病（DM）的存在是ACI和住院治疗的一个预测因素，但静息MPI在糖尿病患者中的作用尚不清楚。
对一项前瞻性、多中心、随机对照试验进行二次数据分析，该试验针对有ACI症状且心电图正常或无诊断意义的患者的急诊科评估策略。在主要试验中，2475例患者被随机分为接受常规急诊科评估策略组（n = 1260）或接受常规策略并辅以静息MPI结果（使用单光子发射计算机断层扫描（SPECT）锝99m甲氧基异丁基异腈）组（n = 1215）。对糖尿病患者（n = 341）进行单独评估。比较糖尿病患者和非糖尿病患者的成像结果、最终诊断、对分流的影响以及SPECT成像的预后价值。在341例糖尿病患者中，153例（45%）被随机分配到成像策略组。糖尿病患者的住院率（66%对49.6%，P = .0001）和ACI发生率（21.1%对12.0%，P < .001）高于非糖尿病患者。在无ACI的糖尿病患者中，常规策略组的入院率为63%，而成像策略组为54%（相对风险[RR] = 0.91 [95% CI，0.76 - 1.06]；P = .24）。与非糖尿病患者相比，这种入院风险降低的幅度没有差异（RR = 0.84 [95% CI，0.77 - 0.92]；非糖尿病患者P = .0002，糖尿病与RR降低的相互作用P = .35）。
使用锝99m甲氧基异丁基异腈进行急性静息MPI与改善有症状的急诊科糖尿病患者的分流决策相关。
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