Clinic of Cardiology, Department of Internal Medicine, City Hospital Triemli, Zurich, Switzerland.
J Nucl Cardiol. 2013 Oct;20(5):755-62. doi: 10.1007/s12350-013-9749-4. Epub 2013 Jul 10.
This study assessed the prognostic value of stress-gated 99mTc-sestamibi myocardial perfusion SPECT (MPS) in patients with multivessel coronary artery disease (CAD) and prior revascularization according to the presence and severity of ischemia.
We studied the outcome of 472 patients with multivessel CAD and prior revascularization (coronary angioplasty, 290 patients; bypass surgery, 182 patients), who underwent exercise or dipyridamole 99mTc-sestamibi MPS for evaluation of ischemia. Visual scoring of perfusion images used 20 segments and a 5-point scale. Gated post-stress EF was automatically calculated. Endpoints included hard events: cardiac death (CD) and nonfatal myocardial infarction (MI). During a mean follow-up of 3.0 ± 1.0 years, 37 hard events occurred, including CD in 15 (3%) and MI in 22 (5%) patients. In a risk-adjusted multivariable Cox model, a history of prior MI, diabetes, abnormal MPS, moderate-to-severe ischemia, and post-stress EF <35% were important predictors of cardiac events. Four-year risk-adjusted survival was 97.9% for normal MPS, 87.3% for abnormal MPS with ischemia, and 82.1% for moderate-to-severe ischemia.
Among patients with previous coronary revascularization, stress-gated 99mTc-sestamibi MPS provides prognostic information for the prediction of cardiac events. A normal perfusion scan confers an excellent prognosis and an exceedingly low hard event rate (<1%/year). The presence of moderate-to-severe ischemia or a post-stress EF <35% identifies patients at highest risk of subsequent cardiac events.
本研究评估了负荷状态下 99mTc-甲氧基异丁基异腈心肌灌注单光子发射断层扫描（MPS）在多支冠状动脉疾病（CAD）且既往接受过血运重建的患者中的预后价值，主要根据缺血的存在和严重程度。
我们研究了 472 例多支 CAD 且既往接受过血运重建（经皮冠状动脉成形术，290 例；冠状动脉旁路移植术，182 例）的患者的预后，这些患者接受了运动或双嘧达莫 99mTc-甲氧基异丁基异腈 MPS 检查以评估缺血情况。使用 20 个节段和 5 分制对灌注图像进行视觉评分。门控后 EF 自动计算。终点包括硬终点：心脏性死亡（CD）和非致死性心肌梗死（MI）。在平均 3.0±1.0 年的随访期间，37 例发生硬终点事件，包括 15 例（3%）CD 和 22 例（5%）MI。在风险调整的多变量 Cox 模型中，既往 MI、糖尿病、MPS 异常、中重度缺血和 EF<35%是心脏事件的重要预测因素。正常 MPS 的 4 年风险调整生存率为 97.9%，异常 MPS 伴缺血的为 87.3%，中重度缺血的为 82.1%。
在既往接受过冠状动脉血运重建的患者中，负荷状态下 99mTc-甲氧基异丁基异腈 MPS 可提供预测心脏事件的预后信息。正常灌注扫描提示预后极好，且硬终点事件发生率极低（<1%/年）。中重度缺血或 EF<35%提示患者发生后续心脏事件的风险最高。
