Conti Alberto, Mariannini Yuri, Canuti Erica, Petrova Tetyana, Innocenti Francesca, Zanobetti Maurizio, Gallini Chiara, Costanzo Egidio
Department of Critical Care Medicine and Surgery, Emergency Medicine, Careggi University Hospital, Florence, Italy.
Department of Nuclear Medicine, Careggi University Hospital, Florence, Italy.
World J Nucl Med. 2014 May;13(2):94-101. doi: 10.4103/1450-1147.139138.
To update the prognostic value of scan strategy with pharmacological stress agent in chest pain (CP) patients presenting with normal electrocardiography (ECG) and troponin.
Two consecutive nonrandomized series of patients with CP and negative first-line workup inclusive of serial ECG, serial troponin, and echocardiography underwent myocardial perfusion imaging single photon emission computed tomography (SPECT) in the emergency department. Of 170 patients enrolled, 52 patients underwent dipyridamole-SPECT and 118 adenosine-SPECT. Patients with perfusion defects underwent angiography, whereas the remaining patients were discharged and followed-up. Primary endpoint was the composite of nonfatal myocardial infarction, unstable angina, revascularization, and cardiovascular death at follow-up or the presence of coronary stenosis > 50% at angiography.
At multivariate analysis, the presence of perfusion defects or hypertension was independent predictor of the primary endpoint. Sensitivity and negative predictive value were higher in patients subjected to adenosine-SPECT (95% and 99%, respectively) versus dipyridamole-SPECT (56% and 89%; yield 70% and 11%, respectively; P < 0.03). Of note, sensitivity, negative, and positive predictive values were high in patients with hypertension (100%, 93%, and 60%, respectively) or nonischemic echocardiography alterations (100%, 100%, and 100%, respectively).
In CP patients, presenting with normal ECG and troponin, adenosine-SPECT adds incremental prognostic values to dipyridamole-SPECT. Costly scan strategy is more appropriate and avoids unnecessary angiograms in patients with hypertension or nonischemic echocardiography alterations.
更新使用药物负荷剂的扫描策略对心电图（ECG）和肌钙蛋白正常的胸痛（CP）患者的预后价值。
连续两个非随机系列的CP患者，其一线检查结果为阴性，包括系列ECG、系列肌钙蛋白和超声心动图，在急诊科接受了心肌灌注成像单光子发射计算机断层扫描（SPECT）。在纳入的170例患者中，52例接受了双嘧达莫-SPECT检查，118例接受了腺苷-SPECT检查。有灌注缺损的患者接受血管造影，其余患者出院并进行随访。主要终点是随访时非致命性心肌梗死、不稳定型心绞痛、血运重建和心血管死亡的复合终点，或血管造影时冠状动脉狭窄>50%。
在多变量分析中，灌注缺损或高血压的存在是主要终点的独立预测因素。与双嘧达莫-SPECT相比，接受腺苷-SPECT检查的患者的敏感性和阴性预测值更高（分别为95%和99%），而双嘧达莫-SPECT的敏感性和阴性预测值分别为56%和89%；检出率分别为70%和11%；P<0.03）。值得注意的是，高血压患者（分别为100%、93%和60%）或非缺血性超声心动图改变患者（分别为100%、100%和100%）的敏感性、阴性和阳性预测值都很高。
在ECG和肌钙蛋白正常的CP患者中，腺苷-SPECT比双嘧达莫-SPECT增加了预后价值。对于高血压或非缺血性超声心动图改变的患者，成本较高的扫描策略更合适，可避免不必要的血管造影。
