Department of Medicine (Cardiology and Nuclear Medicine), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada.
Department of Cardiology, Sanford Health, Fargo, ND, USA.
J Nucl Cardiol. 2020 Aug;27(4):1331-1337. doi: 10.1007/s12350-019-01779-9. Epub 2019 Jul 15.
The incremental value and optimal utilization of non-invasive testing for prediction of peri-operative cardiac events during non-cardiac surgery are not clear.
A sub-study of VISION-CTA was performed using patients who underwent both coronary computed tomography angiography (CCTA) and nuclear myocardial perfusion imaging (MPI) as part of their pre-operative assessment. CCTA images were compared with MPI to determine the correlation between ischemia and obstructive coronary artery disease (CAD). Patients were followed post-operatively for 30 days and primary outcomes were all-cause death and non-fatal myocardial infarction. The predictive capacity of CCTA and nuclear MPI in predicting peri-operative major adverse cardiac event (MACE) was analyzed.
A total of 55 patients (mean age 68.5 ± 8.4 years, 80.0% male) were analyzed. There was a strong correlation between the degree of obstructive CAD and the severity of perfusion abnormalities. Patients with severe CAD (≥ 70% stenosis) had a higher summed stress score than those without severe CAD [4.88 ± 1.22 and 1.30 ± 0.62, respectively (P < .05)]. Similarly summed difference score was significantly higher in patients with severe CAD [1.33 ± 0.46 and 0.17 ± 0.17 (P < .05)]. At 30 days there was a total of 8 (14.5%) MACE. The rate of MACE was higher in patients with severe CAD than those without (20.7% and 7.7%, respectively). Myocardial ischemia appeared to be predictive of MACE with an unadjusted odds ratio of 14.63 (P = .003). The predictive capacity of MPI further improved when only those patients with severe CAD were included (33.00) with a sensitivity, specificity, positive predictive value, and negative predictive value of 100% (79.4-100.0), 72.7% (49.8-89.3), 50.0% (21.1-78.9), and 100% (79.4-100.0), respectively.
Although patients with significant obstructive disease are at risk of peri-operative MACE, the absolute event rate is low. Our data, albeit hypothesis generating, suggest that the peri-operative risk may be refined further by employing nuclear MPI in those with obstructive disease on CCTA.
对于非心脏手术期间预测围手术期心脏事件，非侵入性检查的增量价值和最佳利用尚不清楚。
对 VISION-CTA 进行了一项亚研究，该研究纳入了同时接受冠状动脉计算机断层扫描血管造影术（CCTA）和核心肌灌注成像（MPI）作为术前评估一部分的患者。比较 CCTA 图像与 MPI 以确定缺血与阻塞性冠状动脉疾病（CAD）之间的相关性。术后对患者进行 30 天随访，主要终点为全因死亡和非致死性心肌梗死。分析 CCTA 和核 MPI 在预测围手术期主要不良心脏事件（MACE）中的预测能力。
共分析了 55 例患者（平均年龄 68.5 ± 8.4 岁，80.0%为男性）。阻塞性 CAD 的严重程度与灌注异常的严重程度之间存在很强的相关性。严重 CAD（≥70%狭窄）患者的总和应激评分高于无严重 CAD 患者[分别为 4.88 ± 1.22 和 1.30 ± 0.62（P < 0.05）]。同样，严重 CAD 患者的总和差值评分也明显更高[分别为 1.33 ± 0.46 和 0.17 ± 0.17（P < 0.05）]。在 30 天内共有 8 例（14.5%）MACE。严重 CAD 患者的 MACE 发生率高于无严重 CAD 患者（分别为 20.7%和 7.7%）。心肌缺血似乎与 MACE 具有预测关系，未经调整的优势比为 14.63（P = 0.003）。当仅包括严重 CAD 患者时，MPI 的预测能力进一步提高（33.00），其灵敏度、特异性、阳性预测值和阴性预测值分别为 100%（79.4-100.0）、72.7%（49.8-89.3）、50.0%（21.1-78.9）和 100%（79.4-100.0）。
尽管存在严重阻塞性疾病的患者有围手术期 MACE 的风险，但绝对事件发生率较低。我们的数据尽管只是初步结果，但提示在 CCTA 上存在阻塞性疾病的患者中使用核 MPI 可能会进一步细化围手术期风险。
