Stratmann H G, Mark A L, Walter K E, Williams G A
Department of Cardiology, St. Louis Veterans Administration Medical Center, Missouri 63125.
Am J Cardiol. 1989 Nov 1;64(16):985-90. doi: 10.1016/0002-9149(89)90795-9.
The value of atrial pacing and thallium-201 scintigraphy for assessing risk of subsequent cardiac events was examined in 210 patients with stable chest pain. Follow-up information was complete in 195 patients (mean age 61 years). Over an average follow-up of 19 months, cardiac events occurred in 38 patients--unstable angina in 20, nonfatal acute myocardial infarction in 6 and death from cardiac causes in 12. A history of previous myocardial infarction, diabetes mellitus, systemic hypertension or peripheral vascular disease at the time of pacing was not associated with an increased frequency of subsequent cardiac events. Six of 38 patients with later cardiac events had a history of congestive heart failure, compared with 8 of 157 without cardiac events (p less than 0.05). Neither pacing-induced angina, ST depression, nor the presence of a fixed perfusion defect was significantly more frequent in patients with cardiac events as a whole compared with patients without such events. Reversible defects and abnormal scans (reversible or fixed defects) were present, respectively, in 19 and 31 of 38 patients with cardiac events, compared with 42 and 79 patients, respectively, of the 157 patients without cardiac events (both p less than 0.01). In patients who developed unstable angina, a reversible defect was seen in 13 and an abnormal scan in 16 (both p less than 0.01 compared with patients without cardiac events). In 12 patients who died from a primary cardiac event, fixed defects were present in 8 and an abnormal scan in 11 (p less than 0.05 and p less than 0.01, respectively, compared with patients without cardiac events).(ABSTRACT TRUNCATED AT 250 WORDS)
在210例稳定型胸痛患者中，研究了心房起搏和铊-201闪烁扫描对评估后续心脏事件风险的价值。195例患者（平均年龄61岁）随访信息完整。平均随访19个月，38例患者发生心脏事件——20例为不稳定型心绞痛，6例为非致命性急性心肌梗死，12例死于心脏原因。起搏时既往心肌梗死、糖尿病、系统性高血压或外周血管疾病史与后续心脏事件发生率增加无关。38例发生后续心脏事件的患者中有6例有充血性心力衰竭病史，而157例无心脏事件的患者中有8例有该病史（p<0.05）。与无此类事件的患者相比，发生心脏事件的患者总体上起搏诱发的心绞痛、ST段压低或固定灌注缺损的发生率均无显著增加。38例发生心脏事件的患者中，分别有19例和31例存在可逆性缺损和异常扫描（可逆性或固定性缺损），而157例无心脏事件的患者中分别有42例和79例存在（p均<0.01）。发生不稳定型心绞痛的患者中，13例可见可逆性缺损，16例可见异常扫描（与无心脏事件的患者相比，p均<0.01）。在12例死于原发性心脏事件的患者中，8例存在固定性缺损，11例存在异常扫描（与无心脏事件的患者相比，分别为p<0.05和p<0.01）。（摘要截于250字）
