Department of Nuclear Medicine, Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia.
J Nucl Cardiol. 2012 Dec;19(6):1146-53. doi: 10.1007/s12350-012-9622-x. Epub 2012 Oct 12.
Rest myocardial perfusion imaging (MPI) is effective in managing patients with acute chest pain in developed countries. We aimed to define the role and feasibility of rest MPI in low-to-middle income countries.
Low-to-intermediate risk patients (n = 356) presenting with chest pain to ten centers in eight developing countries were injected with a Tc-99m-based tracer, and standard imaging was performed. The primary outcome was a composite of death, non-fatal myocardial infarction (MI), recurrent angina, and coronary revascularization at 30 days. Sixty-nine patients had a positive MPI (19.4%), and 52 patients (14.6%) had a primary outcome event. An abnormal rest-MPI result was the only variable which independently predicted the primary outcome [adjusted odds ratio (OR) 8.19, 95% confidence interval 4.10-16.40, P = .0001]. The association of MPI result and the primary outcome was stronger (adjusted OR 17.35) when only the patients injected during pain were considered. Rest-MPI had a negative predictive value of 92.7% for the primary outcome, improving to 99.3% for the hard event composite of death or MI.
Our study demonstrates that rest-MPI is a reliable test for ruling out MI when applied to patients in developing countries.
在发达国家，静息心肌灌注成像（MPI）在急性胸痛患者的管理中非常有效。我们旨在确定静息 MPI 在中低收入国家的作用和可行性。
356 名低至中度风险的胸痛患者在 8 个发展中国家的 10 个中心接受了 Tc-99m 示踪剂注射，并进行了标准成像。主要结果是 30 天内死亡、非致死性心肌梗死（MI）、复发性心绞痛和冠状动脉血运重建的复合事件。69 例患者 MPI 阳性（19.4%），52 例患者（14.6%）发生主要结局事件。异常静息-MPI 结果是唯一独立预测主要结局的变量[调整后的优势比（OR）8.19，95%置信区间 4.10-16.40，P=0.0001]。仅考虑疼痛期间注射的患者时，MPI 结果与主要结局的相关性更强（调整后的 OR 17.35）。MPI 对主要结局的阴性预测值为 92.7%，对死亡或 MI 的硬事件复合结局的预测值提高到 99.3%。
我们的研究表明，静息 MPI 是一种在发展中国家患者中排除 MI 的可靠检测方法。
