Mineki Takashi, Yoda Shunichi, Hatta Takumi, Hayase Misa, Monno Koyuru, Hori Yusuke, Suzuki Yasuyuki, Matsumoto Naoya, Okumura Yasuo
Department of Cardiology, Nihon University School of Medicine, Japan.
Intern Med. 2019 Dec 1;58(23):3351-3359. doi: 10.2169/internalmedicine.2843-19. Epub 2019 Jul 31.
Objective We aimed to stratify the risk of major cardiovascular (MCV) events in Japanese patients with known or suspected coronary artery disease (CAD) who had normal single-photon emission computed tomographic myocardial perfusion imaging (SPECT MPI) findings and to compare the risk by generation. Methods This was a retrospective study. The composite endpoint was the occurrence of cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke. Patients The study subjects were 2,035 patients with normal SPECT MPI findings at baseline who had been followed up to confirm their prognosis for 3 years. The patients were categorized into 3 age groups: very elderly (≥80 years old, n=311), elderly (65-79 years old, n=1,097), and younger (<65 years old, n=542). Results During the follow-up, 68 patients experienced MCV events: cardiovascular death (n=29), non-fatal myocardial infarction (n=15), and non-fatal stroke (n=24). The MCV event rate was significantly higher in very elderly patients than in other patients. Multivariate predictors were age categories, the estimated glomerular filtration rate, atrial fibrillation, and stress left ventricular ejection fraction. The MCV event rate was 6.1% in very elderly patients. However, the MCV event rate in those with normal cardiac and renal functions without atrial fibrillation was 3.3%, which was similar to that in elderly and younger patients. Conclusion The MCV event rate was high in very elderly patients despite their normal SPECT MPI findings at baseline. Therefore, very elderly patients with multivariate risks should be carefully followed to avoid a poor prognosis.
目的 我们旨在对已知或疑似患有冠状动脉疾病（CAD）且单光子发射计算机断层扫描心肌灌注成像（SPECT MPI）结果正常的日本患者发生主要心血管（MCV）事件的风险进行分层，并比较不同年代的风险。方法 这是一项回顾性研究。复合终点为心血管死亡、非致命性心肌梗死或非致命性中风的发生。患者 研究对象为2035例基线SPECT MPI结果正常且随访3年以确认其预后的患者。患者被分为3个年龄组：高龄（≥80岁，n = 311）、老年（65 - 79岁，n = 1097）和年轻（<65岁，n = 542）。结果 在随访期间，68例患者发生了MCV事件：心血管死亡（n = 29）、非致命性心肌梗死（n = 15）和非致命性中风（n = 24）。高龄患者的MCV事件发生率显著高于其他患者。多变量预测因素为年龄类别、估计肾小球滤过率、心房颤动和应激性左心室射血分数。高龄患者的MCV事件发生率为6.1%。然而，心脏和肾功能正常且无心房颤动的患者的MCV事件发生率为3.3%，与老年和年轻患者相似。结论 尽管高龄患者基线SPECT MPI结果正常，但其MCV事件发生率仍较高。因此，应密切随访具有多变量风险的高龄患者，以避免不良预后。
