慢性冠状动脉疾病患者中冠状动脉CT血管造影与负荷心肌SPECT联合风险分层的可行性。
Feasibility of combined risk stratification with coronary CT angiography and stress myocardial SPECT in patients with chronic coronary artery disease.
作者信息
Kiriyama Tomonari, Fukushima Yoshimitsu, Hayashi Hiromitsu, Takano Hitoshi, Kumita Shin-Ichiro
机构信息
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.
出版信息
Ann Nucl Med. 2018 Jan;32(1):22-33. doi: 10.1007/s12149-017-1214-z. Epub 2017 Oct 6.
OBJECTIVE
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.
METHODS
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).
RESULTS
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).
CONCLUSION
Coronary CT angiography may provide additional prognostic information over MPI.
目的
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。
方法
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）。
结果
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）。
结论
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。
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