Kaya Hakki, Kandemir Ozan, Beton Osman, Kivrak Tarik, Kurt Recep, Yilmaz Mehmet Birhan
Department of Cardiology, Cumhuriyet University Medical School, Sivas, Turkey.
Department of Nuclear Medicine, Sivas State Hospital, Sivas, Turkey.
World J Nucl Med. 2017 Jul-Sep;16(3):212-217. doi: 10.4103/1450-1147.207279.
In this study, we compared the patients who underwent coronary angiography (CAG), followed by revascularization by coronary artery stent implantation according to the CAG results without any evidence of ischemia with myocardial perfusion scintigraphy (MPS), and the patients who underwent revascularization by coronary artery stent implantation following the detection of ischemia in MPS before CAG in terms of the mortality and hospitalization due to acute coronary syndrome (ACS). Between January 2009 and January 2016, a total of 407 patients (52% males, 48% females; mean age: 66 ± 9 years; range: 40-85 years) who underwent CAG following diagnosis of stable angina and underwent coronary artery stenting were retrospectively analyzed. The patients were divided into two groups: Group 1 ( = 200) included those who had MPS before CAG and in whom ischemia was detected and stent was implanted, and Group 2 ( = 207) included those who had stent implantation according to the CAG results without prior MPS. The mean follow-up was 40 ± 18 months. Although there was no significant difference in the mortality rates between the groups, the rate of hospitalization due to ACS was significantly lower in Group 1 ( = 0.112 vs. = 0.022, respectively). According to the multivariate Cox-regression analysis, demonstration of ischemia in MPS before revascularization, statin use, clopidogrel use, and higher high-density lipoprotein cholesterol levels were found to be associated with a reduced risk of ACS-related hospitalization, whereas the presence of diabetes mellitus and smoking was found to be associated with an increased risk of ACS-related hospitalization.
在本研究中，我们比较了两组患者：一组是先接受冠状动脉造影（CAG），然后根据CAG结果在无任何缺血证据的情况下通过冠状动脉支架植入术进行血运重建，且未进行心肌灌注显像（MPS）的患者；另一组是在CAG前通过MPS检测到缺血后再通过冠状动脉支架植入术进行血运重建的患者，比较两组患者急性冠状动脉综合征（ACS）导致的死亡率和住院情况。在2009年1月至2016年1月期间，对407例诊断为稳定型心绞痛后接受CAG并进行冠状动脉支架置入术的患者（男性占52%，女性占48%；平均年龄：66±9岁；范围：40 - 85岁）进行了回顾性分析。患者被分为两组：第1组（n = 200）包括在CAG前进行了MPS且检测到缺血并植入支架的患者；第2组（n = 207）包括根据CAG结果在未进行MPS的情况下植入支架的患者。平均随访时间为40±18个月。虽然两组之间的死亡率没有显著差异，但第1组因ACS导致的住院率显著较低（分别为 = 0.112和 = 0.022）。根据多因素Cox回归分析，血运重建前MPS显示缺血、使用他汀类药物、使用氯吡格雷以及较高的高密度脂蛋白胆固醇水平与ACS相关住院风险降低有关，而糖尿病和吸烟则与ACS相关住院风险增加有关。
