Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
Netherlands Heart Institute, Utrecht, the Netherlands.
Eur Heart J Cardiovasc Imaging. 2017 Sep 1;18(9):969-977. doi: 10.1093/ehjci/jex055.
The aim of this study was to assess the impact of adding stress computed tomography (CT) myocardial perfusion (CTP) to coronary CT angiography (CTA) on downstream referral for invasive coronary angiography (ICA), revascularization, and outcome in patients presenting with new-onset chest pain.
Three hundred and eighty-four patients were referred for cardiac CT. Patients with lesions ≥50% stenosis underwent subsequently stress CTP. Perfusion scans were considered abnormal if a defect was observed in ≥ 1 segment. Downstream performance of ICA, revascularization, and the occurrence of major cardiovascular events (death, non-fatal myocardial infarction, and unstable angina requiring urgent revascularization) were assessed within 12 months. In total, 119 patients showed ≥50% stenosis on coronary CTA; stress CTP was normal in 61 patients, abnormal in 38 patients and was not performed in 20 patients. After normal stress CTP, 19 (31%) patients underwent ICA and 9 (15%) underwent revascularization. After abnormal stress CTP, 36 (95%) patients underwent ICA and 29 (76%) revascularizations were performed. Multivariable analyses showed a five-fold reduction in likelihood of proceeding to ICA when a normal stress CTP was added to a coronary CTA showing obstructive CAD. Major cardiovascular event rates at 12 months for patients with obstructive CAD and normal stress CTP (N = 61) were low: 1 myocardial infarction, 1 urgent revascularization, and 1 non-cardiac death.
The performance of stress CTP in patients with obstructive CAD at coronary CTA in the same setting is feasible and reduces the referral rate for ICA and revascularization. Secondly, the occurrence of major cardiovascular events at 12 months follow-up in patients with normal stress CTP is low.
本研究旨在评估在新发胸痛患者中，将冠状动脉 CT 血管造影（CTA）与应激 CT 心肌灌注（CTP）相结合对后续行有创冠状动脉造影（ICA）、血运重建和预后的影响。
共 384 例患者接受心脏 CT 检查。对存在≥50%狭窄病变的患者行应激 CTP。如果观察到≥1 个节段存在缺损，则认为灌注扫描异常。在 12 个月内评估 ICA、血运重建以及主要心血管事件（死亡、非致死性心肌梗死和需要紧急血运重建的不稳定型心绞痛）的发生情况。共 119 例患者的冠状动脉 CTA 显示≥50%狭窄；61 例患者的应激 CTP 正常，38 例患者异常，20 例患者未行检查。在正常应激 CTP 后，19 例（31%）患者行 ICA，9 例（15%）患者行血运重建。在异常应激 CTP 后，36 例（95%）患者行 ICA，29 例（76%）患者行血运重建。多变量分析显示，在冠状动脉 CTA 显示阻塞性 CAD 并联合行正常应激 CTP 检查时，行 ICA 的可能性降低了 5 倍。阻塞性 CAD 且应激 CTP 正常的患者（n=61）在 12 个月时的主要心血管事件发生率较低：1 例心肌梗死、1 例紧急血运重建和 1 例非心脏性死亡。
在同一情况下，对冠状动脉 CTA 显示阻塞性 CAD 的患者行应激 CTP 检查是可行的，可降低 ICA 和血运重建的转诊率。其次，应激 CTP 正常的患者在 12 个月随访时主要心血管事件的发生率较低。
