经皮冠状动脉介入治疗后（99m）锝-替曲膦心肌单光子发射计算机断层扫描的增量预后价值。

Incremental prognostic value of (99m)Tc-tetrofosmin myocardial SPECT after percutaneous coronary intervention.

作者信息

Georgoulias Panagiotis, Tzavara Chara, Demakopoulos Nikolaos, Giannakou Stavroula, Valotassiou Varvara, Tsougos Ioannis, Xaplanteris Petros, Fezoulidis Ioannis

机构信息

Department of Nuclear Medicine, University Hospital of Larissa, Mezourlo, Larissa 41110, Greece.

出版信息

Ann Nucl Med. 2008 Dec;22(10):899-909. doi: 10.1007/s12149-008-0191-7. Epub 2009 Jan 8.

DOI:10.1007/s12149-008-0191-7

PMID:19142709

Abstract

OBJECTIVE

Percutaneous transluminal coronary angioplasty is a well-established therapeutic method in selected patients with coronary artery disease. The aim of this study was to assess the incremental prognostic value of technetium-99m ((99m)Tc)-tetrofosmin myocardial gated-single- photon emission computed tomography (SPECT) in asymptomatic patients after coronary artery stenting.

METHODS

A total of 246 consecutive patients (aged 55.5 +/- 8.2 years, 182 men) participated in the study with a median follow-up of 9.5 years (interquartile ra 5.8-10.5 years). All patients underwent exercise gated-SPECT myocardial imaging within 5-7 months. Myocardial scintigrams were performed using 99mTc-tetrofosmin, and were evaluated calculating the summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS) indexes. Cardiovascular death and non-fatal myocardial infarction were considered as hard cardiac events, and late revascularization (>3 months after myocardial SPECT) procedures as soft events. Receiver-operating characteristic (ROC) analysis was used to test the prognostic ability of SSS and SDS for cardiac events. Cox proportional hazards models were used to evaluate the incremental value of SPECT variables.

RESULTS

Cardiac death occurred in 12 (4.9%) patients and non-fatal myocardial infarction in 20 (8.1%) patients. In addition, 60 (24.4%) patients underwent a late revascularization procedure. Using ROC analysis the optimal cut-offs of SSS (AUC = 0.94; 95% CI 0.92-0.97) and SDS (AUC = 0. 76; 95% CI 0.70-0.82) for the prediction of cardiac events were 10 and 1.7, respectively. Multiple Cox regression analyses revealed that SSS > 10 (HR = 24.2; 95% CI 7.44-78.79) and SDS > 1.7 (HR = 2.72; 95% CI 1.23-6.00) provided incremental prognostic value over clinical and exercise test data for the composite end points of any cardiac event.

CONCLUSIONS

(99m)Tc-tetrofosmin myocardial gated- SPECT, performed 6 months post-percutaneous coronary intervention (PCI), provides incremental prognostic information for the prediction of cardiac events in asymptomatic patients after PCI.

摘要

目的

经皮腔内冠状动脉成形术是治疗特定冠心病患者的一种成熟治疗方法。本研究旨在评估锝-99m（99mTc）-替曲膦心肌门控单光子发射计算机断层扫描（SPECT）在冠状动脉支架置入术后无症状患者中的增量预后价值。

方法

共有246例连续患者（年龄55.5±8.2岁，男性182例）参与本研究，中位随访时间为9.5年（四分位间距5.8 - 10.5年）。所有患者在5 - 7个月内接受运动门控SPECT心肌成像检查。使用99mTc - 替曲膦进行心肌闪烁扫描，并通过计算总应力评分（SSS）、总静息评分（SRS）和总差异评分（SDS）指数进行评估。心血管死亡和非致死性心肌梗死被视为严重心脏事件，晚期血运重建（心肌SPECT检查后>3个月）手术被视为软性事件。采用受试者操作特征（ROC）分析来测试SSS和SDS对心脏事件的预后能力。使用Cox比例风险模型评估SPECT变量的增量价值。

结果

12例（4.9%）患者发生心脏死亡，20例（8.1%）患者发生非致死性心肌梗死。此外，60例（24.4%）患者接受了晚期血运重建手术。通过ROC分析，预测心脏事件时SSS（曲线下面积[AUC]=0.94；95%可信区间[CI]0.92 - 0.97）和SDS（AUC = 0.76；95%CI 0.70 - 0.82）的最佳截断值分别为10和1. .7。多因素Cox回归分析显示，对于任何心脏事件的复合终点，SSS>10（风险比[HR]=24.2；95%CI 7.44 - 78.79）和SDS>1.7（HR = 2.72；95%CI 1.23 - 6.00）相对于临床和运动试验数据具有增量预后价值。