在已知患有严重多支血管冠状动脉疾病（CAD）的患者中，负荷试验中的缺血负担是否会影响患者的生存率？

Does ischemic burden on stress testing influence patient survival in subjects with known severe multi-vessel CAD?

作者信息

Mukundan Shey, Travin Mark I, Levsky Jeffrey M, Liakos Matthew P, Spevack Daniel M

机构信息

Montefiore Medical Center/Albert Einstein College of MedicineBronx, NY, USA.

Stony Brook University Hospital, Stony BrookNY, USA.

出版信息

Am J Cardiovasc Dis. 2017 Apr 15;7(2):48-52. eCollection 2017.

PMID:28533929

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5435604/

Abstract

BACKGROUND

Ischemic burden observed during stress testing has been postulated to predict prognosis irrespective of anatomic atherosclerotic burden observed on angiography. However, it is not known if the stress test result influences the long-term prognosis of subjects with diffuse coronary artery disease. We sought to determine the prognostic importance of stress test false negativity amongst patients with severe multi-vessel coronary artery disease (CAD) undergoing stress testing in the previous decade.

METHODS

We selected subjects from the dates of 1/1/2000 to 12/31/2005 who underwent a nuclear stress test (MPI) or stress echocardiogram (SE) within six months of a coronary angiogram demonstrating severe, multi-vessel CAD. We excluded those with a prior MI, PCI, CABG, resting wall motion abnormality, or perfusion defect at rest. Determination of patient death during the followup period was performed using the U.S. social security index.

RESULTS

139 subjects (MPI 81, SE 58) were studied; stress tests were positive for ischemia in 80%. Rates of death were similar at 1 year (MPI 9%, SE 5%, -value 0.44), 5 years (MPI 20%, SE 14%, -value 0.36) and 10 years (MPI 30%, SE 26%, -value 0.63). Using multivariate analysis, mortality at each time period was not affected by stress test positivity.

CONCLUSION

Amongst subjects with diffuse and severe atherosclerosis with preserved ventricular function, ischemic burden on stress testing did not influence short or long-term survival.

摘要

背景

应激试验中观察到的缺血负荷被假定可预测预后，而与血管造影观察到的解剖学动脉粥样硬化负荷无关。然而，尚不清楚应激试验结果是否会影响弥漫性冠状动脉疾病患者的长期预后。我们试图确定在过去十年中接受应激试验的严重多支冠状动脉疾病（CAD）患者中，应激试验假阴性的预后重要性。

方法

我们从2000年1月1日至2005年12月31日期间，在冠状动脉造影显示严重多支CAD后六个月内接受核素应激试验（MPI）或应激超声心动图（SE）的患者中进行选择。我们排除了既往有心肌梗死、经皮冠状动脉介入治疗（PCI）、冠状动脉旁路移植术（CABG）、静息壁运动异常或静息灌注缺损的患者。使用美国社会保障指数确定随访期间的患者死亡情况。

结果

研究了139名受试者（MPI 81名，SE 58名）；应激试验缺血阳性率为80%。1年（MPI 9%，SE 5%，P值0.44）、5年（MPI 20%，SE 14%，P值0.36）和10年（MPI 30%，SE 26%，P值0.63）时的死亡率相似。使用多变量分析，每个时间段的死亡率不受应激试验阳性的影响。