疑似冠心病患者心肌灌注成像对院内冠状动脉造影和血运重建的影响。

Impact of myocardial perfusion imaging on in-hospital coronary angiography and revascularization of patients with suspected coronary artery disease.

机构信息

Department of Nuclear Medicine, Fuwai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China.

出版信息

Chin Med J (Engl). 2011 Jun;124(11):1603-9.

PMID:21740763

Abstract

BACKGROUND

Noninvasive cardiac imaging is now central to the diagnosis and management of patients with moderate probability for coronary artery disease. The aim of this study was to assess the impact of stress myocardial perfusion single photon emission computerized tomography (SPECT) on in-hospital coronary angiography and revascularization for such patients.

METHODS

Between January 2005 and June 2007, 1053 consecutive in-hospital patients (423 women, the average age of (57.2 ± 11.2) years) with suspected coronary artery disease but without any prior interventional treatment were retrospectively analyzed. All patients underwent a 2-day stress/rest (99m)Tc-methoxyisobutylisonitrile (MIBI) myocardial perfusion SPECT, including 984 exercise test and 69 adenosine test.

RESULTS

Overall, stress/rest myocardial perfusion SPECT was normal in 973 patients (92.4%) and abnormal in 80 patients (7.6%). A total of 190 patients underwent coronary angiography, 46 underwent percutaneous coronary intervention and 10 coronary artery bypass grafting during hospitalization. From the whole perspective, only 14.7% of patients with normal SPECT underwent coronary angiography, so did 58.8% of patients with abnormal SPECT (χ(2) = 97.0, P < 0.001); furthermore, the rates of revascularization in patients with normal and abnormal SPECT were 2.8% and 36.3%, respectively (27 out of 973 vs. 29 out of 80, χ(2) = 157.9, P < 0.001). The extent and severity of ischemia did not add more predictive value for subsequent coronary angiography, but did have impact on revascularization. Multivariate analysis showed that reversible perfusion defect was the most predictive variable for referral rate to coronary angiography (odds ratio = 7.5, P < 0.001).

CONCLUSIONS

Abnormal myocardial perfusion SPECT is a powerful referral for in-hospital coronary angiography and revascularization during the same hospitalization. Thus, stress/rest SPECT is an effective gatekeeper for early coronary angiography and invasive treatment for patients with suspected coronary artery disease.

摘要

背景

非侵入性心脏成像现在是诊断和治疗中度冠心病患者的核心手段。本研究旨在评估应激心肌灌注单光子发射计算机断层扫描（SPECT）对这些患者住院期间冠状动脉造影和血运重建的影响。

方法

2005 年 1 月至 2007 年 6 月，连续回顾性分析了 1053 例疑似冠心病但无任何介入治疗史的住院患者（女性 423 例，平均年龄（57.2±11.2）岁）。所有患者均接受了为期 2 天的应激/静息（99m）Tc-甲氧基异丁基异腈（MIBI）心肌灌注 SPECT，包括 984 次运动试验和 69 次腺苷试验。

结果

总的来说，973 例患者（92.4%）的应激/静息心肌灌注 SPECT 正常，80 例（7.6%）异常。共有 190 例患者接受了冠状动脉造影，46 例接受了经皮冠状动脉介入治疗，10 例接受了冠状动脉旁路移植术。从整体上看，只有 14.7%的 SPECT 正常患者进行了冠状动脉造影，SPECT 异常患者的比例为 58.8%（χ(2) = 97.0，P < 0.001）；此外，SPECT 正常和异常患者的血运重建率分别为 2.8%和 36.3%（973 例中有 27 例，80 例中有 29 例，χ(2) = 157.9，P < 0.001）。缺血的程度和严重程度并没有为随后的冠状动脉造影提供更多的预测价值，但确实对血运重建有影响。多变量分析显示，可逆灌注缺陷是冠状动脉造影转诊率的最具预测性变量（优势比=7.5，P < 0.001）。