Acampa Wanda, Cantoni Valeria, Green Roberta, Maio Francesca, Daniele Stefania, Nappi Carmela, Gaudieri Valeria, Punzo Giorgio, Petretta Mario, Cuocolo Alberto
Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy.
J Nucl Cardiol. 2014 Oct;21(5):893-902; quiz 890-2, 903-5. doi: 10.1007/s12350-014-9918-0. Epub 2014 Jun 13.
The prognostic value of normal stress myocardial perfusion single-photon emission computed tomography (MPS) in patients with diabetes has only been evaluated in single-center studies of relatively limited sample size. We performed a meta-analysis of published studies, including diabetic patients with known or suspected coronary artery disease (CAD), to assess the predictive value for adverse cardiac ischemic events of normal stress MPS.
Studies published between January 1990 and December 2013 were identified by database search. We included studies using stress MPS to evaluate diabetic patients with known or suspected CAD and providing data on clinical outcomes of non-fatal myocardial infarction or cardiac death with a follow-up time ≥12 months. A total of 14 studies were finally included, recruiting 13,493 patients. The negative predictive value (NPV) for non-fatal myocardial infarction and cardiac death of normal MPS was 94.92% (95% confidence interval 93.67-96.05), during a weighted mean follow-up of 36.24 months, resulting in estimated event rate after a negative test equal to 5.08% (95% confidence interval 3.95-6.33). The corresponding annualized event rate after a negative test was 1.60% (95% confidence interval 1.21-2.04).
Stress MPS has a high NPV for adverse cardiac events in diabetic patients with known or suspected CAD leading to define a "relatively low-risk" patients category.
正常应激心肌灌注单光子发射计算机断层扫描（MPS）在糖尿病患者中的预后价值仅在样本量相对有限的单中心研究中得到评估。我们对已发表的研究进行了荟萃分析，纳入已知或疑似冠状动脉疾病（CAD）的糖尿病患者，以评估正常应激MPS对不良心脏缺血事件的预测价值。
通过数据库检索确定1990年1月至2013年12月期间发表的研究。我们纳入了使用应激MPS评估已知或疑似CAD的糖尿病患者并提供非致命性心肌梗死或心源性死亡临床结局数据且随访时间≥12个月的研究。最终共纳入14项研究，招募了13493例患者。在加权平均随访36.24个月期间，正常MPS对非致命性心肌梗死和心源性死亡的阴性预测值（NPV）为94.92%（95%置信区间93.67 - 96.05），阴性试验后的估计事件发生率为5.08%（95%置信区间3.95 - 6.33）。阴性试验后的相应年化事件发生率为1.60%（95%置信区间1.21 - 2.04）。
应激MPS对已知或疑似CAD的糖尿病患者不良心脏事件具有较高的NPV，从而可定义出“相对低风险”患者类别。
