Petretta Mario, Acampa Wanda, Daniele Stefania, Zampella Emilia, Assante Roberta, Nappi Carmela, Salvatore Marco, Cuocolo Alberto
Department of Translational Medical Sciences, University of Naples Federico II.
Circ J. 2016;80(2):485-93. doi: 10.1253/circj.CJ-15-1093. Epub 2015 Dec 18.
We assessed the relationship between clinical outcome and coronary revascularization according to stress-gated myocardial perfusion single-photon emission computed tomography (MPS) in an observational series of patients with suspected or known coronary artery disease (CAD), on long-term follow-up.
The study group consisted of 2,059 patients. During a median follow-up of 61 months, 184 events occurred (126 cardiac deaths and 58 non-fatal MI). The impact of revascularization during follow-up on event-free survival was evaluated using an extended Cox regression model, adjusting for potential clinical and MPS confounders. Revascularization was treated as a binary non-reversible time-dependent covariate. Predefined interactions tested were: (1) revascularization and summed difference score (SDS); (2) revascularization and post-stress left ventricular (LV) ejection fraction (EF); and (3) SDS and post-stress LVEF. Revascularization had a significant effect on event-free survival (adjusted HR, 0.19; P<0.001). Significant interactions were found between revascularization and SDS (P=0.045), and between LVEF and SDS (P=0.015). The protective effect of revascularization increased as SDS increased. For SDS <6 the reduction in HR was detectable only for reduced LVEF.
Both the degree of stress-induced ischemia and LVEF predict the effect of revascularization on outcome in patients with suspected or known CAD. The protective effect of revascularization appears to be greater in patients with severe ischemia and preserved LVEF.
在一项针对疑似或已知冠心病（CAD）患者的观察性系列研究的长期随访中，我们根据应力门控心肌灌注单光子发射计算机断层扫描（MPS）评估了临床结局与冠状动脉血运重建之间的关系。
研究组由2059例患者组成。在中位随访61个月期间，发生了184起事件（126例心源性死亡和58例非致命性心肌梗死）。使用扩展的Cox回归模型评估随访期间血运重建对无事件生存的影响，并对潜在的临床和MPS混杂因素进行校正。血运重建被视为二元不可逆的时间依赖性协变量。测试的预定义相互作用为：（1）血运重建与总和差异评分（SDS）；（2）血运重建与应激后左心室（LV）射血分数（EF）；以及（3）SDS与应激后LVEF。血运重建对无事件生存有显著影响（校正后HR，0.19；P<0.001）。在血运重建与SDS之间（P=0.045）以及LVEF与SDS之间（P=0.015）发现了显著的相互作用。随着SDS的增加，血运重建的保护作用增强。对于SDS<6，仅在LVEF降低时可检测到HR的降低。
应激诱导的缺血程度和LVEF均可预测血运重建对疑似或已知CAD患者结局的影响。血运重建对严重缺血且LVEF保留的患者的保护作用似乎更大。
