Department of Imaging, Division of Nuclear Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
Circulation. 2009 Dec 1;120(22):2197-206. doi: 10.1161/CIRCULATIONAHA.108.817387. Epub 2009 Nov 16.
The goal of this study was to assess the clinical value of stress myocardial perfusion scintigraphy (MPS) in elderly patients (> or =75 years of age).
We followed up 5200 elderly patients (41% exercise) after dual-isotope MPS over 2.8+/-1.7 years (362 cardiac deaths [CDs], 7.0%, 2.6%/y) and a subset with extended follow-up (684 patients for 6.2+/-2.9 years; 320 all-cause deaths). Survival modeling of CD revealed that both MPS-measured ischemia and fixed defect added incrementally to pre-MPS data in both adenosine and exercise stress patients. Modeling a subset with gated MPS (n=2472) revealed that ejection fraction and perfusion data added incrementally to each other, further enhancing risk stratification. Unadjusted, annualized post-normal MPS CD rate was 1.3% but <1% in patients with normal rest ECG, exercise stress, or age of 75 to 84 years and was 2.3% to 3.7% in patients > or =85 years of age or undergoing pharmacological stress. However, compared with age-matched US population CD rates (75 to 84 years of age, 1.5%; > or =85 years, 4.8%), normal MPS CD rates were approximately one-third lower than the baseline risk of US individuals (both P<0.05). Modeling of all-cause death in 684 patients with extended follow-up revealed that after risk adjustment, an interaction between early treatment and ischemia was present; increasing ischemia was associated with increasing survival with early revascularization, whereas in the setting of little or no ischemia, medical therapy had improved outcomes.
Stress MPS effectively stratifies CD risk in elderly patients and may identify optimal post-MPS therapy. CD rates after normal MPS are low in all subsets in relative terms compared with the age-matched US population.
本研究旨在评估应激心肌灌注闪烁显像（MPS）在老年患者（≥75 岁）中的临床价值。
我们对 5200 例接受双核素 MPS 检查的老年患者（41%为运动试验）进行了 2.8±1.7 年（362 例心脏死亡[CD]，7.0%，2.6%/年）的随访，并对部分患者进行了扩展随访（684 例，6.2±2.9 年；320 例全因死亡）。CD 生存模型显示，腺苷和运动应激患者的 MPS 测量缺血和固定性缺损均在 MPS 前数据中呈附加性增加。对 2472 例门控 MPS 患者进行建模分析，发现射血分数和灌注数据彼此呈附加性增加，进一步增强了风险分层。未调整的、经年化的 MPS 后正常期 CD 发生率为 1.3%，但在静息心电图正常、运动应激或年龄 75 至 84 岁的患者中<1%，在年龄≥85 岁或进行药物应激的患者中为 2.3%至 3.7%。然而，与年龄匹配的美国人群 CD 发生率（75 至 84 岁，1.5%；≥85 岁，4.8%）相比，MPS 后正常 CD 发生率约为美国个体的基础风险的三分之一（均 P<0.05）。对 684 例进行扩展随访的患者的全因死亡进行建模分析，发现风险调整后，早期治疗和缺血之间存在交互作用；缺血增加与早期血运重建的生存率增加相关，而在缺血很少或没有的情况下，药物治疗改善了预后。
应激 MPS 可有效对老年患者的 CD 风险进行分层，并且可能确定最佳的 MPS 后治疗。与年龄匹配的美国人群相比，MPS 后正常期在所有亚组中相对来说 CD 发生率较低。
