Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland.
Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland.
Int J Cardiol. 2018 Jun 15;261:218-222. doi: 10.1016/j.ijcard.2018.01.118.
Although randomized trials have provided evidence for invasive fractional flow reserve to guide revascularization, evidence for non-invasive imaging is less well established. The present study investigated whether hybrid coronary computed tomography (CCTA)/single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) can identify patients who benefit from early revascularization compared to medical therapy.
This retrospective study consists of 414 patients referred for evaluation of known or suspected coronary artery disease (CAD) with CCTA/SPECT hybrid imaging. CCTA categorized patients into no CAD, non-high-risk CAD and high-risk CAD. In patients with CAD (n = 329), a matched finding (n = 75) was defined as a reversible perfusion defect in a territory subtended by a coronary artery with CAD. All other combinations of pathologic findings were classified as unmatched (n = 254). Death, myocardial infarction, unstable angina requiring hospitalization, and late coronary revascularization were defined as major adverse cardiac events (MACE). Cox hazards models included covariates age, male gender, more than two risk factors, previous CABG, high-risk CAD and early revascularization.
During median follow-up of 6.0 years, 112 patients experienced a MACE (27%). Early revascularization (n = 50) was independently associated with improved outcome among patients with a matched finding (p < 0.001). There was no benefit among patients with an unmatched finding (p = 0.787), irrespective of presence (p = 0.505) or absence of high-risk CAD (p = 0.631).
Early revascularization is associated with an outcome benefit in CAD patients with a matched finding documented by cardiac hybrid imaging while no benefit of revascularization was observed in patients with an unmatched finding.
虽然随机试验已经提供了有创性分数血流储备指导血运重建的证据，但非侵入性影像学的证据还不太明确。本研究旨在探讨冠状动脉计算机断层扫描（CCTA）/单光子发射计算机断层扫描（SPECT）心肌灌注成像（MPI）的混合成像是否可以识别出与药物治疗相比从早期血运重建中获益的患者。
这项回顾性研究纳入了 414 例因已知或疑似冠状动脉疾病（CAD）而行 CCTA/SPECT 混合成像检查的患者。CCTA 将患者分为无 CAD、非高危 CAD 和高危 CAD。在 CAD 患者中（n=329），将匹配发现（n=75）定义为 CAD 相关冠状动脉供血区域内的可逆灌注缺损。其他病理发现的所有组合均归类为不匹配（n=254）。死亡、心肌梗死、需要住院治疗的不稳定型心绞痛和晚期冠状动脉血运重建定义为主要不良心脏事件（MACE）。Cox 风险模型包括年龄、男性、超过两个危险因素、既往 CABG、高危 CAD 和早期血运重建等协变量。
在中位 6.0 年的随访期间，112 例患者发生了 MACE（27%）。在有匹配发现的患者中，早期血运重建（n=50）与改善预后独立相关（p<0.001）。在不匹配发现的患者中，早期血运重建没有获益（p=0.787），无论是否存在高危 CAD（p=0.505）或不存在高危 CAD（p=0.631）。
在心脏混合成像有匹配发现的 CAD 患者中，早期血运重建与预后改善相关，而在不匹配发现的患者中，血运重建没有获益。
