Kang Se Hun, Choi Hyo In, Kim Young Hak, Lee Eun Young, Ahn Jung Min, Han Seungbong, Lee Pil Hyung, Roh Jae Hyung, Yun Sung Han, Park Duk Woo, Kang Soo Jin, Lee Seung Whan, Lee Cheol Whan, Moon Dae Hyuk, Park Seong Wook, Park Seung Jung
Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Yonsei Med J. 2017 Sep;58(5):934-943. doi: 10.3349/ymj.2017.58.5.934.
Few studies have reported on predicting prognosis using myocardial perfusion single-photon emission computed tomography (SPECT) during coronary artery disease (CAD) treatment. Therefore, we aimed to assess the clinical implications of myocardial perfusion SPECT during follow-up for CAD treatment.
We enrolled 1153 patients who had abnormal results at index SPECT and underwent follow-up SPECT at intervals ≥6 months. Major adverse cardiac events (MACE) were compared in overall and 346 patient pairs after propensity-score (PS) matching.
Abnormal SPECT was associated with a significantly higher risk of MACE in comparison with normal SPECT over the median of 6.3 years (32.3% vs. 19.8%; unadjusted p<0.001). After PS matching, abnormal SPECT posed a higher risk of MACE [32.1% vs. 19.1%; adjusted hazard ratio (HR)=1.73; 95% confidence interval (CI)=1.27-2.34; p<0.001] than normal SPECT. After PS matching, the risk of MACE was still higher in patients with abnormal follow-up SPECT in the revascularization group (30.2% vs. 17.9%; adjusted HR=1.73; 95% CI=1.15-2.59; p=0.008). Low ejection fraction [odds ratio (OR)=5.33; 95% CI=3.39-8.37; p<0.001] and medical treatment (OR=2.68; 95% CI=1.93-3.72; p<0.001) were independent clinical predictors of having an abnormal result on follow-up SPECT.
Abnormal follow-up SPECT appears to be associated with a high risk of MACE during CAD treatment. Follow-up SPECT may play a potential role in identifying patients at high cardiovascular risk.
很少有研究报道在冠状动脉疾病（CAD）治疗期间使用心肌灌注单光子发射计算机断层扫描（SPECT）预测预后。因此，我们旨在评估心肌灌注SPECT在CAD治疗随访期间的临床意义。
我们纳入了1153例初始SPECT结果异常且每隔≥6个月接受一次随访SPECT检查的患者。在倾向得分（PS）匹配后，对1153例患者整体以及346对患者的主要不良心脏事件（MACE）进行了比较。
在6.3年的中位数随访期内，与正常SPECT相比，异常SPECT与MACE风险显著更高相关（32.3%对19.8%；未调整p<0.001）。PS匹配后，异常SPECT发生MACE的风险高于正常SPECT[32.1%对19.1%；调整后风险比（HR）=1.73；95%置信区间（CI）=1.27 - 2.34；p<0.001]。PS匹配后，血运重建组中随访SPECT异常的患者发生MACE的风险仍然更高（30.2%对17.9%；调整后HR=1.73；95%CI=1.15 - 2.59；p=0.008）。低射血分数[比值比（OR）=5.33；95%CI=3.39 - 8.37；p<0.001]和药物治疗（OR=2.68；95%CI=1.93 - 3.72；p<0.001）是随访SPECT结果异常的独立临床预测因素。
随访SPECT异常似乎与CAD治疗期间MACE的高风险相关。随访SPECT可能在识别心血管高风险患者方面发挥潜在作用。
