Kiriyama Tomonari, Fukushima Yoshimitsu, Hayashi Hiromitsu, Takano Hitoshi, Kumita Shin-Ichiro
Department of Radiology, Graduate School of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
Division of Cardiology, Hepatology, Geriatrics, and Integrated Medicine, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.
Ann Nucl Med. 2018 Jan;32(1):22-33. doi: 10.1007/s12149-017-1214-z. Epub 2017 Oct 6.
To examine the additional prognostic value of coronary CT angiography (CTA) over myocardial perfusion imaging (MPI) in patients with suspected or known coronary artery disease.
A series of 157 patients (mean age 69 ± 9 years; 76% male; median follow-up 49 months; range 12-82 months) underwent stress MPI with SPECT and coronary CTA within a 6-month interval. Summed stress score (SSS) and summed difference score (SDS) of stress MPI, number of vessels with stenosis, and presence of left main trunk stenosis and high-risk plaques on coronary CTA were examined. Primary endpoints were cardiac death, acute myocardial infarction, or unstable angina requiring revascularization. Secondary endpoints were revascularization > 60 days after the latter imaging test. All patients were followed up for at least 1 year (mean 45 ± 19 months; range 12-82 months).
Nine (6%) patients reached primary endpoints. Cardiac death occurred in 1 (0.6%) patient, myocardial infarction in 5 (3%), and unstable angina requiring hospitalization in 3 (2%). Elective revascularization within 60 days was performed in 31 (20%) patients. Sixteen (10%) patients required revascularization after > 60 days. Primary endpoint event-free survival rates were significantly lower in patients with myocardial ischemia (SDS ≥ 2) and high-risk plaques (HRP), and secondary endpoint event-free survival rates in patients with SSS ≥ 4 and 3VD. In multivariate analysis, Cox proportional hazards regression analysis revealed HRP (HR = 8.02; P = 0.006) and myocardial ischemia (HR = 11.487; P = 0.025) were significant predictors of primary endpoints, and 3VD of secondary endpoints (HR = 4.981; P = 0.008). Combined ischemia and HRP resulted in the significant increase of the model Chi square in prediction of primary end points from ischemia or HRP alone (17.4 vs. 9.41; P = 0.005, 17.4 vs. 9.39; P = 0.005, respectively).
Coronary CT angiography may provide additional prognostic information over MPI.
探讨冠状动脉CT血管造影（CTA）相较于心肌灌注成像（MPI）在疑似或已知冠心病患者中的额外预后价值。
157例患者（平均年龄69±9岁；76%为男性；中位随访49个月；范围12 - 82个月）在6个月内先后接受了单光子发射计算机断层扫描（SPECT）负荷心肌灌注成像和冠状动脉CTA检查。分析了负荷心肌灌注成像的负荷总分（SSS）、负荷差值总分（SDS）、冠状动脉狭窄血管数量、冠状动脉CTA上左主干狭窄及高危斑块的存在情况。主要终点为心源性死亡、急性心肌梗死或需要血运重建的不稳定型心绞痛。次要终点为后一项成像检查60天之后的血运重建。所有患者均随访至少1年（平均45±19个月；范围12 - 82个月）。
9例（6%）患者达到主要终点。1例（0.6%）患者发生心源性死亡，5例（3%）发生心肌梗死，3例（2%）发生需要住院治疗的不稳定型心绞痛。31例（20%）患者在60天内接受了择期血运重建。16例（10%）患者在60天之后需要血运重建。心肌缺血（SDS≥2）和高危斑块（HRP）患者的主要终点无事件生存率显著较低，SSS≥4和三支血管病变（3VD）患者的次要终点无事件生存率较低。在多变量分析中，Cox比例风险回归分析显示高危斑块（HR = 8.02；P = 0.006）和心肌缺血（HR = 11.487；P = 0.025）是主要终点的显著预测因素，三支血管病变是次要终点的显著预测因素（HR = 4.981；P = 0.008）。缺血与高危斑块并存导致在预测主要终点时，相较于单独的缺血或高危斑块，模型卡方值显著增加（分别为17.4对9.41；P = 0.005，17.4对9.39；P = 0.005）。
冠状动脉CT血管造影可能比心肌灌注成像提供更多的预后信息。
