Bülow H, Schwaiger M
Nuklearmedizinische Klinik und Poliklinik Technische Universität München, Klinikum rechts der Isar, Ismaninger-Strasse 22, 81675 Munich, Germany.
Q J Nucl Med Mol Imaging. 2005 Mar;49(1):59-71.
Acute coronary syndromes are a frequent manifestation of coronary artery disease, usually being associated with chest pain and presenting as a medical emergency. Since a considerable number of patients with chest pain, however, have a non cardiac etiology of their pain, properly triaging these patients represents a diagnostic challenge for physicians in the emergency department. As the available diagnostic procedures have limited accuracy, many different diagnostic strategies have been evaluated. Among these, radionuclide myocardial perfusion imaging (MPI) at rest or in combination with stress procedures has been investigated in many trials. MPI has been proven to be useful, especially in a patient population with a low to intermediate probability of an ischemic event. Perfusion scintigraphy has a high sensitivity in the detection of myocardial infarction and reveals an excellent negative predictive value, allowing a safe discharge strategy of patients with a negative scan result. Moreover, it enables risk stratification and provides incremental and independent prognostic information regarding short to long term future cardiac adverse events. Several cost effectiveness studies have shown that perfusion imaging leads to lower overall direct costs, mainly by a reduction of unnecessary hospital admissions and diagnostic angiograms, without worsening of the clinical outcome of these patients. As a possible study endpoint, myocardial perfusion imaging in the acute setting enables the quantification of salvaged myocardium and therefore the evaluation of treatment efficacy. Besides perfusion agents, several infarct avid radiopharmaceuticals have been developed, which in part show promising results. However, larger randomized trials evaluating these tracers in clinical settings are needed to warrant routine clinical application.
急性冠状动脉综合征是冠状动脉疾病的常见表现，通常伴有胸痛，是一种医疗急症。然而，由于相当一部分胸痛患者的疼痛病因并非心脏问题，对这些患者进行恰当分诊对急诊科医生来说是一项诊断挑战。由于现有的诊断方法准确性有限，人们评估了许多不同的诊断策略。其中，静息状态下或与负荷检查相结合的放射性核素心肌灌注显像（MPI）已在许多试验中得到研究。MPI已被证明是有用的，尤其是在缺血事件发生概率低至中等的患者群体中。灌注闪烁显像在检测心肌梗死方面具有高灵敏度，并显示出出色的阴性预测价值，使得扫描结果为阴性的患者能够采取安全的出院策略。此外，它还能进行危险分层，并提供有关短期至长期未来心脏不良事件的增量和独立的预后信息。多项成本效益研究表明，灌注显像可降低总体直接成本，主要是通过减少不必要的住院和诊断性血管造影，而不会使这些患者的临床结局恶化。作为一个可能的研究终点，急性情况下的心肌灌注显像能够对挽救的心肌进行定量，从而评估治疗效果。除了灌注剂，还开发了几种梗死灶摄取放射性药物，其中一些显示出有前景的结果。然而，需要在临床环境中对这些示踪剂进行更大规模的随机试验，以确保其常规临床应用。
