有症状患者中，除单光子发射计算机断层扫描心肌灌注成像外，冠状动脉钙化评分的预后价值

Prognostic Value of Coronary Artery Calcium Scoring in Addition to Single-Photon Emission Computed Tomographic Myocardial Perfusion Imaging in Symptomatic Patients.

作者信息

Engbers Elsemiek M, Timmer Jorik R, Ottervanger Jan Paul, Mouden Mohamed, Knollema Siert, Jager Pieter L

机构信息

From the Departments of Cardiology (E.M.E., J.R.T., J.P.O., M.M.) and Nuclear Medicine (E.M.E., M.M., S.K., P.L.J.), Isala Hospital, Zwolle, Netherlands.

出版信息

Circ Cardiovasc Imaging. 2016 May;9(5). doi: 10.1161/CIRCIMAGING.115.003966.

DOI:10.1161/CIRCIMAGING.115.003966

PMID:27165700

Abstract

BACKGROUND

The prognostic value of coronary artery calcium (CAC) scoring on top of myocardial perfusion imaging with single-photon emission computed tomography (SPECT) in patients suspected for coronary artery disease is not well established.

METHODS AND RESULTS

Four thousand eight hundred ninety-seven symptomatic patients without a history of coronary artery disease referred for SPECT and CAC scoring were included. Major adverse cardiac events (MACEs) were defined as late revascularization (>90 days after scanning), nonfatal myocardial infarction, and all-cause mortality. The frequency of abnormal SPECT increased with higher CAC scores, from 12% in patients with CAC scores of 0 to 19%, 32%, 37%, and 50% among those with CAC scores 1 to 99, 100 to 399, 400 to 999, and ≥1000, respectively (P<0.001). During a median follow-up of 940 days (25th to 75th percentile, 581-1377), a total of 278 MACEs were observed. Overall incidence of MACE was 2.3% per year. A stepwise increase of MACE was present with increasing CAC scores, both in patients with normal SPECT (annual event rate CAC score 0: 0.6%; CAC score ≥1000: 5.5%) and abnormal SPECT (annual event rate CAC score 0: 0.4%; CAC score ≥1000: 7.6%). After multivariate analysis, both SPECT and CAC score were independent predictors of MACE (CAC score ≥1000: hazard ratio, 7.7; P<0.001 and large perfusion defect on SPECT: hazard ratio, 3.7; P<0.001).

CONCLUSIONS

CAC score and SPECT are independent predictors of MACE in patients suspected for coronary artery disease. Our findings strongly support performing a CAC score in addition to SPECT in symptomatic patients to better define the risk of events during follow-up.

摘要

背景

对于疑似冠心病患者，在单光子发射计算机断层扫描（SPECT）心肌灌注成像基础上进行冠状动脉钙化（CAC）评分的预后价值尚未明确。

方法与结果

纳入4897例有症状且无冠心病病史的患者，进行SPECT和CAC评分。主要不良心脏事件（MACE）定义为晚期血运重建（扫描后>90天）、非致命性心肌梗死和全因死亡率。SPECT异常的频率随CAC评分升高而增加，CAC评分为0的患者中为12%，而在CAC评分为1至99、100至399、400至999和≥1000的患者中分别为19%、32%、37%和50%（P<0.001）。在中位随访940天（第25至75百分位数，581 - 1377天）期间，共观察到278例MACE。MACE的总体发生率为每年2.3%。无论SPECT正常（年度事件发生率：CAC评分为0时为0.6%；CAC评分≥1000时为5.5%）还是异常（年度事件发生率：CAC评分为0时为0.4%；CAC评分≥1000时为7.6%），MACE均随CAC评分升高而逐步增加。多因素分析后，SPECT和CAC评分均为MACE的独立预测因素（CAC评分≥1000：风险比，7.7；P<0.001；SPECT上大灌注缺损：风险比，3.7；P<0.001）。