Malcom Randall VAMC, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd, Box 111-D, Gainesville, FL USA.
Division of Cardiovascular Medicine, University of Florida College of Medicine, Malcom Randall VAMC, 1601 SW Archer Rd, Box 111-D, Gainesville, FL USA.
Mil Med Res. 2017 Apr 1;4:12. doi: 10.1186/s40779-017-0121-x. eCollection 2017.
The prevalence of ischemia on nuclear myocardial perfusion imaging (MPI) has been decreasing. Recent research has questioned the benefit of invasive revascularization for patients with moderate to severe ischemia. We hypothesized that patients with moderate to severe ischemia could routinely undergo successful revascularization.
We analyzed data from 544 patients who underwent an MPI at a single academic Veterans Affairs Medical Center. Patients with moderate to severe ischemia, defined as a summed difference score (SDS) 8 or greater, were compared to the rest of the cohort.
Of the total cohort ( = 544), 39 patients had MPI studies with resultant moderate to severe ischemia. Patients with ischemia were more likely to develop coronary artery disease (74.4% versus 38.8%, < 0.0001) and have successful revascularization (38.5% versus 4.0%, < 0.0001) during the following year. Revascularization was attempted in 31 patients with moderate to severe ischemia, though only 15 (47%) of these attempts were successful. Ischemia was predictive of myocardial infarction (5.1% versus 0.8%, = 0.01) within 1 year.
Moderate to severe ischemia is an uncommon finding in a contemporary nuclear laboratory. Among patients with ischemia, revascularization is typically attempted but is frequently unsuccessful.
This trial does not appear on a registry as it is neither randomized nor prospective.
核素心肌灌注成像（MPI）显示的缺血患病率一直在下降。最近的研究对中度至重度缺血患者进行有创血管重建的获益提出了质疑。我们假设中度至重度缺血的患者可以常规进行成功的血运重建。
我们分析了在单一学术退伍军人事务医疗中心进行 MPI 的 544 名患者的数据。将中度至重度缺血（定义为总和差值评分 [SDS] 8 或更高）的患者与其余队列进行比较。
在总队列（ = 544）中，有 39 名患者的 MPI 研究显示中度至重度缺血。有缺血的患者更有可能发展为冠状动脉疾病（74.4%比 38.8%， < 0.0001），并在接下来的一年中进行成功的血运重建（38.5%比 4.0%， < 0.0001）。在 31 名有中度至重度缺血的患者中尝试了血运重建，但只有 15 名（47%）尝试成功。缺血可预测 1 年内发生心肌梗死（5.1%比 0.8%， = 0.01）。
在当代核实验室中，中度至重度缺血是一种罕见的发现。在有缺血的患者中，通常会尝试进行血运重建，但通常不成功。
本试验未在注册处登记，因为它既不是随机的也不是前瞻性的。
