Savvopoulos Christos A, Spyridonidis Trifon, Papandrianos Nikolaos, Vassilakos Pavlos J, Alexopoulos Dimitrios, Apostolopoulos Dimitris J
Department of Nuclear Medicine, University Hospital of Patras, University of Patras, Medical School, Rion, 26500, Patras, Greece.
J Nucl Cardiol. 2014 Jun;21(3):519-31. doi: 10.1007/s12350-014-9867-7. Epub 2014 Feb 15.
Previous studies advocate the use of attenuation correction in myocardial perfusion scintigraphy (MPS) for patient risk stratification.
Six-hundred and thirty-seven unselected patients underwent Tl-201 MPS by a hybrid SPECT/CT system. Attenuation-corrected (AC) and non-corrected (NAC) images were interpreted blindly and summed stress scores (SSS) were calculated. Study endpoints were all-cause mortality and the composites of death/non-fatal acute myocardial infarction (AMI) and death/AMI/late revascularization.
During a follow-up of 42.3 ± 12.8 months 24 deaths, 13 AMIs and 28 revascularizations were recorded. SSS groups formed according to event rate distribution across SSS values were: 0-4, 5-13, >13 for NAC and 0-2, 3-9, >9 for AC. Kaplan-Meier functions were statistically significant between NAC SSS groups for all study endpoints. AC discriminated only between SSS 0-2 and >9 for death/AMI and between 0-2 and 3-9 for death/AMI/revascularization. In the univariate Cox regression abnormal NAC (SSS > 4) was accompanied with much higher hazards ratios than abnormal AC (SSS > 2). In the multivariate model abnormal AC yielded no significance for either endpoint whereas abnormal NAC proved independent from other covariates for the composite endpoints.
Our results challenge the effectiveness of CT-based AC for risk stratification of patients referred for MPS.
先前的研究提倡在心肌灌注显像（MPS）中使用衰减校正来对患者进行风险分层。
637例未经筛选的患者通过SPECT/CT混合系统接受了铊-201 MPS检查。对衰减校正（AC）图像和未校正（NAC）图像进行盲法解读，并计算总应力评分（SSS）。研究终点为全因死亡率以及死亡/非致命性急性心肌梗死（AMI）和死亡/AMI/晚期血运重建的复合终点。
在42.3±12.8个月的随访期间，记录到24例死亡、13例AMI和28例血运重建。根据SSS值的事件发生率分布形成的SSS组为：NAC组为0 - 4、5 - 13、>13，AC组为0 - 2、3 - 9、>9。对于所有研究终点，NAC SSS组之间的Kaplan-Meier函数具有统计学意义。AC仅在死亡/AMI的SSS 0 - 2和>9之间以及死亡/AMI/血运重建的0 - 2和3 - 9之间有区分能力。在单变量Cox回归中，异常NAC（SSS>4）的风险比远高于异常AC（SSS>2）。在多变量模型中，异常AC对任何一个终点均无显著性，而异常NAC被证明对于复合终点独立于其他协变量。
我们的结果对基于CT的AC在接受MPS检查患者风险分层中的有效性提出了质疑。
