直接经皮冠状动脉介入治疗（PCI）后单光子发射计算机断层心肌灌注显像对 ST 段抬高型心肌梗死（STEMI）患者的长期预后价值。
Long-term prognostic value of single-photon emission computed tomography myocardial perfusion imaging after primary PCI for STEMI.
机构信息
Department of Cardiology, Leiden University Medical Center, Postal Zone 2300 RC, Albinusdreef 2, ZA, Leiden, The Netherlands.
Department of Nuclear Medicine, Leiden University Medical Center, 2300 RC, Albinusdreef 2, ZA, Leiden, The Netherlands.
出版信息
Eur Heart J Cardiovasc Imaging. 2018 Nov 1;19(11):1287-1293. doi: 10.1093/ehjci/jex332.
AIMS
The aim of this study was to determine the long-term prognostic value of infarct size and myocardial ischaemia on single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI) after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).
METHODS AND RESULTS
In total, 1092 STEMI patients who underwent primary PCI and SPECT MPI within 1-6 months were included (median follow-up time of 6.9 years). In the entire cohort, SPECT infarct size was independently associated with the composite of cardiac death or reinfarction [hazard ratio (HR) per 10% increase in summed rest score 1.33; 95% confidence interval (95% CI) 1.12-1.58; P = 0.001], whereas myocardial ischaemia was not (HR per 5% increase in summed difference score 1.18; 95% CI 0.94-1.48; P = 0.16). Addition of SPECT infarct size to a model including the clinical variables provided significant incremental prognostic value for the prediction of cardiac death or reinfarction (global χ2 13.8 vs. 24.2; P = 0.002), whereas addition of SPECT ischaemia did not add significantly (global χ2 24.2 vs. 25.6; P = 0.24). In the subgroup of patients with left ventricular ejection fraction (LVEF) ≤ 45%, SPECT infarct size was independently associated with cardiac death or reinfarction (HR 1.59; 95% CI 1.15-2.22; P = 0.006), whereas in patients with LVEF > 45%, only SPECT ischaemia was independently associated with cardiac death or reinfarction (HR 1.28; 95% CI 1.00-1.63; P = 0.050).
CONCLUSION
In patients with first STEMI and primary PCI, SPECT infarct size was independently associated with cardiac death and/or reinfarction, whereas myocardial ischaemia was not. In patients with LVEF ≤ 45%, SPECT infarct size was independently associated with cardiac death or reinfarction, whereas myocardial ischaemia was not. Conversely, in patients with LVEF > 45%, only SPECT ischaemia was independently associated with cardiac death or reinfarction.
目的
本研究旨在确定 ST 段抬高型心肌梗死（STEMI）患者行直接经皮冠状动脉介入治疗（PCI）后，单光子发射计算机断层心肌灌注显像（SPECT MPI）检测的梗死面积和心肌缺血对长期预后的预测价值。
方法和结果
共纳入 1092 例 STEMI 患者，他们在 1-6 个月内行直接 PCI 和 SPECT MPI 检查（中位随访时间为 6.9 年）。在整个队列中，SPECT 梗死面积与心脏死亡或再梗死的复合终点独立相关[每增加 10%总和静息评分的危险比（HR）为 1.33；95%置信区间（95%CI）为 1.12-1.58；P=0.001]，而心肌缺血则没有（总和差值评分每增加 5%的 HR 为 1.18；95%CI 为 0.94-1.48；P=0.16）。将 SPECT 梗死面积加入包括临床变量的模型中，为心脏死亡或再梗死的预测提供了显著的附加预后价值（整体 χ2 值为 13.8 比 24.2；P=0.002），而加入 SPECT 缺血则没有显著增加（整体 χ2 值为 24.2 比 25.6；P=0.24）。在左心室射血分数（LVEF）≤45%的患者亚组中，SPECT 梗死面积与心脏死亡或再梗死独立相关（HR 为 1.59；95%CI 为 1.15-2.22；P=0.006），而在 LVEF＞45%的患者中，只有 SPECT 缺血与心脏死亡或再梗死独立相关（HR 为 1.28；95%CI 为 1.00-1.63；P=0.050）。
结论
在首次发生 STEMI 且行直接 PCI 的患者中，SPECT 梗死面积与心脏死亡和/或再梗死独立相关，而心肌缺血则不然。在 LVEF≤45%的患者中，SPECT 梗死面积与心脏死亡或再梗死独立相关，而心肌缺血则不然。相反，在 LVEF＞45%的患者中，只有 SPECT 缺血与心脏死亡或再梗死独立相关。
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