From the Department of Nuclear Medicine (A.P.P., D.C.B., C.G., M.A.M., F.M., E.v.F., T.A.F., B.H.M., J.S., O.G., R.R.B., P.A.K.) and Department of Cardiology, University Heart Center (A.P.P., T.F.L., O.G.), University Hospital Zurich, Ramistr 100, NUK D 6, CH-8091 Zurich, Switzerland.
Radiology. 2018 Sep;288(3):694-702. doi: 10.1148/radiol.2018171303. Epub 2018 Jul 3.
Purpose To determine the value of cardiac hybrid imaging, performed by combining SPECT myocardial perfusion imaging (MPI) with coronary CT angiography, as a long-term predictor for major adverse cardiac events (MACEs) (death, myocardial infarction [MI], unstable angina requiring hospitalization, coronary revascularization). Materials and Methods For this retrospective single-center study, 428 patients referred between May 2005 and December 2008 were classified according to hybrid imaging findings into the following groups: (a) those with stenosis of 50% or greater (at coronary CT angiography) with ischemia (at SPECT) in subtended territory (matched), (b) those with coronary CT angiography and/or SPECT findings in unrelated territories (unmatched), and (c) those with normal findings at coronary CT angiography and SPECT. End points were all-cause death or MI ("hard events") and a composite of MACEs. The Kaplan-Meier method was used to identify survival free of MACEs, and Cox proportional hazard regression analysis was used to determine independent predictors for MACE. Results During a median follow-up of 6.8 years, a total of 160 MACEs, including 45 deaths, were observed in the final study population (mean age, 62 years ± 11 [standard deviation]; 132 women). The annual hard event rate was more than fivefold higher for patients with matched findings (n = 46 [7.0%]) and was threefold higher for patients with unmatched findings (n = 113 [3.7%]) compared with that for patients with normal findings (1.2%; n = 216 [1.2%]; P < .001). The MACE rates were 21.8%, 9.0%, and 2.4% for matched, unmatched, and normal findings, respectively. A matched finding was an independent predictor for MACE and hard events. Conclusion In patients evaluated for coronary artery disease, cardiac hybrid imaging is an excellent long-term predictor of adverse cardiac events. A matched hybrid finding is associated with a high annual cardiac event rate. © RSNA, 2018.
目的 确定 SPECT 心肌灌注成像（MPI）与冠状动脉 CT 血管造影相结合的心脏混合成像的价值，作为主要不良心脏事件（MACE）（死亡、心肌梗死[MI]、需要住院治疗的不稳定型心绞痛、冠状动脉血运重建）的长期预测指标。
材料与方法 本回顾性单中心研究纳入 2005 年 5 月至 2008 年 12 月期间转诊的 428 例患者，根据混合成像结果将其分为以下三组：（a）冠状动脉 CT 血管造影显示狭窄程度≥50%（狭窄）且 SPECT 显示有缺血（缺血）的患者（匹配）；（b）冠状动脉 CT 血管造影和/或 SPECT 显示非相关区域存在异常的患者（不匹配）；（c）冠状动脉 CT 血管造影和 SPECT 均正常的患者。终点为全因死亡或 MI（“硬终点事件”）以及 MACE 复合终点。采用 Kaplan-Meier 法确定无 MACE 生存情况，采用 Cox 比例风险回归分析确定 MACE 的独立预测因素。
结果 在中位随访 6.8 年期间，最终研究人群中共有 160 例 MACE，包括 45 例死亡（平均年龄，62 岁±11[标准差]；132 例女性）。与正常发现者（1.2%；n=216，1.2%）相比，匹配发现者（n=46，7.0%）和不匹配发现者（n=113，3.7%）的年度硬终点事件发生率高出 5 倍以上（P<.001）。匹配发现者的 MACE 发生率为 21.8%，不匹配发现者为 9.0%，正常发现者为 2.4%。匹配发现是 MACE 和硬终点事件的独立预测因素。
结论 在评估冠状动脉疾病的患者中，心脏混合成像可作为不良心脏事件的极佳长期预测指标。匹配的混合成像结果与高年度心脏事件发生率相关。
