Mowatt Graham, Brazzelli Miriam, Gemmell Howard, Hillis Graham S, Metcalfe Malcolm, Vale Luke
Health Services Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
Nucl Med Commun. 2005 Mar;26(3):217-29. doi: 10.1097/00006231-200503000-00006.
In patients with suspected or known coronary artery disease (CAD), or following myocardial infarction (MI), assessing the degree of ischaemia is important from a prognostic and therapeutic point of view. Single photon emission computed tomography (SPECT) myocardial perfusion scintigraphy (MPS) is a non-invasive technique that allows the presence, location and extent of ischaemia to be determined. The aim of this systematic review was to assess the prognostic effectiveness of SPECT MPS.
We sought prognostic studies involving SPECT, exercise tolerance testing (ETT) and/or coronary angiography (CA) in people with suspected or known CAD, or following MI. Outcomes included cardiac death, non-fatal MI and revascularization. We searched the following databases: MEDLINE, PREMEDLINE, EMBASE, BIOSIS, Science Citation Index, the Cochrane Library, the Health Management Information Consortium and the Health Technology Assessment Database.
Twenty-one observational studies enrolling 53,762 people reported the general prognostic value of SPECT MPS. In multivariate analysis, SPECT MPS variables yielded both independent and incremental value to combinations of clinical, ETT and angiographic variables in predicting cardiac death or non-fatal MI. Three comparative studies reported lower revascularization rates following a SPECT MPS-CA strategy (6-21%) compared with direct CA (16-44%). Four observational studies enrolling 2106 people reported the prognostic value of SPECT for patients following MI. In multivariate analysis including clinical history, ETT, SPECT MPS and angiographic variables, strategies involving SPECT MPS provided independent and incremental prognostic performance in predicting future cardiac events.
SPECT MPS provides important additional information to that from ETT and/or CA that helps to risk-stratify patients with suspected or known CAD or following MI, enabling them to be managed more appropriately. Increasing the use of strategies involving SPECT MPS may identify lower risk patients for whom invasive CA might be avoided.
对于疑似或已知患有冠状动脉疾病（CAD）的患者，或心肌梗死（MI）后患者，从预后和治疗角度评估缺血程度很重要。单光子发射计算机断层扫描（SPECT）心肌灌注显像（MPS）是一种无创技术，可确定缺血的存在、位置和范围。本系统评价的目的是评估SPECT MPS的预后有效性。
我们检索了涉及疑似或已知CAD患者或MI后患者的SPECT、运动耐量试验（ETT）和/或冠状动脉造影（CA）的预后研究。结局包括心源性死亡、非致死性MI和血运重建。我们检索了以下数据库：MEDLINE、PREMEDLINE、EMBASE、BIOSIS、科学引文索引、Cochrane图书馆、卫生管理信息联盟和卫生技术评估数据库。
21项纳入53762人的观察性研究报告了SPECT MPS的总体预后价值。在多变量分析中，SPECT MPS变量在预测心源性死亡或非致死性MI方面，相对于临床、ETT和血管造影变量的组合具有独立和增量价值。三项比较研究报告，与直接CA（16 - 44%）相比，SPECT MPS - CA策略后的血运重建率较低（6 - 21%）。四项纳入2106人的观察性研究报告了SPECT对MI后患者的预后价值。在包括临床病史、ETT、SPECT MPS和血管造影变量的多变量分析中，涉及SPECT MPS的策略在预测未来心脏事件方面具有独立和增量的预后性能。
SPECT MPS提供了ETT和/或CA之外的重要附加信息，有助于对疑似或已知CAD患者或MI后患者进行危险分层，使其得到更恰当的管理。增加涉及SPECT MPS策略的使用可能会识别出可避免进行有创CA的低风险患者。
