Chen Marcus Y, Rochitte Carlos E, Arbab-Zadeh Armin, Dewey Marc, George Richard T, Miller Julie M, Niinuma Hiroyuki, Yoshioka Kunihiro, Kitagawa Kakuya, Sakuma Hajime, Laham Roger, Vavere Andrea L, Cerci Rodrigo J, Mehra Vishal C, Nomura Cesar, Kofoed Klaus F, Jinzaki Masahiro, Kuribayashi Sachio, Scholte Arthur J, Laule Michael, Tan Swee Yaw, Hoe John, Paul Narinder, Rybicki Frank J, Brinker Jeffrey A, Arai Andrew E, Matheson Matthew B, Cox Christopher, Clouse Melvin E, Di Carli Marcelo F, Lima João A C
From the Laboratory of Cardiac Energetics, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C., A.E.A.); InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil (C.E.R.); Johns Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524, Baltimore, MD 21287 (A.A., R.T.G., J.M.M., A.L.V., R.J.C., V.C.M., J.A.B., J.A.C.L.); Department of Radiology, Charité Medical School-Humboldt, Berlin, Germany (M.D., M.L.); Memorial Heart Center, Iwate Medical University, Morioka, Japan (H.N., K.Y.); Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (H.N.); Department of Radiology, Mie University Hospital, Tsu, Japan (K.K., H.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Mass (R.L., M.E.C.); and Radiology Sector, Hospital Israelita Albert Einstein, São Paulo, Brazil (C.N.); From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (K.F.K.); Keio University School of Medicine, Tokyo, Japan (M.J., S.K.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (A.J.S.); Department of Cardiology, National Heart Centre, Singapore (S.Y.T.); Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore (J.H.); Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada (N.P.); Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (F.J.R.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (M.B.M., C.C.); and Department of Nuclear Medicine and Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Mass (M.F.D.C.).
Radiology. 2017 Jul;284(1):55-65. doi: 10.1148/radiol.2017161565. Epub 2017 Mar 14.
Purpose To compare the prognostic importance (time to major adverse cardiovascular event [MACE]) of combined computed tomography (CT) angiography and CT myocardial stress perfusion imaging with that of combined invasive coronary angiography (ICA) and stress single photon emission CT myocardial perfusion imaging. Materials and Methods This study was approved by all institutional review boards, and written informed consent was obtained. Between November 2009 and July 2011, 381 participants clinically referred for ICA and aged 45-85 years were enrolled in the Combined Noninvasive Coronary Angiography and Myocardial Perfusion Imaging Using 320-Detector Row Computed Tomography (CORE320) prospective multicenter diagnostic study. All images were analyzed in blinded independent core laboratories, and a panel of physicians adjudicated all adverse events. MACE was defined as revascularization (>30 days after index ICA), myocardial infarction, or cardiac death; hospitalization for chest pain or congestive heart failure; or arrhythmia. Late MACE was defined similarly, except for patients who underwent revascularization within the first 182 days after ICA, who were excluded. Comparisons of 2-year survival (time to MACE) used standard Kaplan-Meier curves and restricted mean survival times bootstrapped with 2000 replicates. Results An MACE (49 revascularizations, five myocardial infarctions, one cardiac death, nine hospitalizations for chest pain or congestive heart failure, and one arrhythmia) occurred in 51 of 379 patients (13.5%). The 2-year MACE-free rates for combined CT angiography and CT perfusion findings were 94% negative for coronary artery disease (CAD) versus 82% positive for CAD and were similar to combined ICA and single photon emission CT findings (93% negative for CAD vs 77% positive for CAD, P < .001 for both). Event-free rates for CT angiography and CT perfusion versus ICA and single photon emission CT for either positive or negative results were not significantly different for MACE or late MACE (P > .05 for all). The area under the receiver operating characteristic curve (AUC) for combined CT angiography and CT perfusion (AUC = 68; 95% confidence interval [CI]: 62, 75) was similar (P = .36) to that for combined ICA and single photon emission CT (AUC = 71; 95% CI: 65, 79) in the identification of MACE at 2-year follow-up. Conclusion Combined CT angiography and CT perfusion enables similar prediction of 2-year MACE, late MACE, and event-free survival similar to that enabled by ICA and single photon emission CT. RSNA, 2017 Online supplemental material is available for this article.
目的 比较联合计算机断层扫描（CT）血管造影和CT心肌负荷灌注成像与联合有创冠状动脉造影（ICA）和负荷单光子发射CT心肌灌注成像对主要不良心血管事件（MACE）预后的重要性（至MACE发生时间）。材料与方法 本研究经所有机构审查委员会批准，并获得书面知情同意。在2009年11月至2011年7月期间，381名临床转诊接受ICA检查、年龄在45 - 85岁之间的参与者被纳入使用320排探测器CT进行的联合无创冠状动脉造影和心肌灌注成像（CORE320）前瞻性多中心诊断研究。所有图像均在盲法独立核心实验室进行分析，一组医生对所有不良事件进行判定。MACE定义为血运重建（在首次ICA后>30天）、心肌梗死或心源性死亡；因胸痛或充血性心力衰竭住院；或心律失常。晚期MACE定义类似，但排除ICA后182天内接受血运重建的患者。2年生存率（至MACE发生时间）的比较采用标准Kaplan-Meier曲线和经2000次重复抽样的受限平均生存时间。结果 379例患者中有51例（13.5%）发生MACE（49例血运重建、5例心肌梗死、1例心源性死亡、9例因胸痛或充血性心力衰竭住院、1例心律失常）。联合CT血管造影和CT灌注检查结果显示，2年无MACE发生率在冠状动脉疾病（CAD）阴性者中为94%，CAD阳性者中为82%，与联合ICA和单光子发射CT检查结果相似（CAD阴性者中为93%，CAD阳性者中为77%，两者P均<0.001）。CT血管造影和CT灌注与ICA和单光子发射CT检查结果无论是阳性还是阴性，其MACE或晚期MACE的无事件发生率均无显著差异（所有P>0.05）。在2年随访中，联合CT血管造影和CT灌注的受试者操作特征曲线下面积（AUC = 68；95%置信区间[CI]：62, 75）与联合ICA和单光子发射CT的（AUC = 71；95% CI：65, 79）相似（P = 0.36），用于识别MACE。结论 联合CT血管造影和CT灌注对2年MACE、晚期MACE及无事件生存的预测能力与ICA和单光子发射CT相似。RSNA，2017 本文可获取在线补充材料。
