多巴酚丁胺负荷超声心动图与计算机断层冠状动脉成像术在非心脏手术患者中的预后准确性的头对头比较（PANDA 试验）：一项前瞻性观察研究。

Head-to-head comparison of prognostic accuracy in patients undergoing noncardiac surgery of dobutamine stress echocardiography versus computed tomography coronary angiography (PANDA trial): A prospective observational study.

机构信息

Division of Cardiology, Department of Internal Medicine, Gyeongsang National University, School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea.

Division of Cardiology, Department of Internal Medicine, Gyeongsang National University, School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea.

出版信息

J Cardiovasc Comput Tomogr. 2020 Nov-Dec;14(6):471-477. doi: 10.1016/j.jcct.2020.02.001. Epub 2020 Feb 4.

DOI:10.1016/j.jcct.2020.02.001

PMID:32057706

Abstract

BACKGROUND

Dobutamine stress echocardiography (DSE) and coronary computed tomography angiography (CTA) can provide perioperative prognostic information in risk stratification of patients undergoing noncardiac surgery. This study directly compared the prognostic value of DSE and CTA in patients undergoing noncardiac surgery.

METHODS

Between 2014 and 2016, 215 patients with more than one clinical risk factor for perioperative cardiovascular (CV) events were enrolled prospectively. They received both DSE and CTA before noncardiac surgery. Perioperative clinical risk was classified according to the revised cardiac risk index (RCRI), DSE results were categorized as abnormal (inducible ischemia and/or nonviable infarction) or not. CTA results were assessed using the severity of stenosis, with significant stenosis being ≥50% of the luminal diameter). After the exclusion, a total of 206 patients remained. Perioperative CV events were defined as CV death, non-fatal myocardial infarction (MI), myocardial injury, pulmonary edema, non-fatal stroke, and systemic embolism within 30 days after surgery.

RESULTS

Twenty-four patients (12%) had perioperative cardiac events (1 cardiac death, 10 non-fatal MI, 8 myocardial injury, 11 pulmonary edema, 1 non-fatal stroke, and 1 pulmonary embolism). Following adjustment for baseline RCRI score, abnormal result on DSE (OR, 6.08, 95% CI, 2.41 to 15.31, P < 0.001), significant CAD on CTA (OR, 18.79; 95% CI, 5.24 to 67.42, P < 0.001), and high CACS (OR, 4.19; 95% CI, 1.39 to 12.60, P = 0.011) remained significant predictors of perioperative CV events.

CONCLUSIONS

DSE and CTA are independent predictive factors of events in patients undergoing noncardiac surgery. Among them, assessment of significant CAD using CTA might show a higher prognostic value compared with DSE before noncardiac surgery.

CLINICAL TRIAL REGISTRATION

URL: http://www.clinicaltrials.gov. Unique identifier: NCT02250963.

摘要

背景

多巴酚丁胺负荷超声心动图（DSE）和冠状动脉计算机断层血管造影（CTA）可提供围手术期预后信息，用于非心脏手术患者的风险分层。本研究直接比较了 DSE 和 CTA 在非心脏手术患者中的预后价值。

方法

2014 年至 2016 年，前瞻性纳入 215 例有一个以上围手术期心血管（CV）事件临床危险因素的患者。他们在非心脏手术前接受了 DSE 和 CTA 检查。根据修订后的心脏风险指数（RCRI）对围手术期临床风险进行分类，DSE 结果分为异常（可诱导缺血和/或无存活心肌梗死）或正常。使用狭窄程度评估 CTA 结果，狭窄程度≥50%管腔直径为显著狭窄）。排除后，共有 206 例患者入组。围手术期 CV 事件定义为术后 30 天内发生 CV 死亡、非致命性心肌梗死（MI）、心肌损伤、肺水肿、非致命性卒中和全身栓塞。

结果

24 例患者（12%）发生围手术期心脏事件（1 例心脏死亡，10 例非致命性 MI，8 例心肌损伤，11 例肺水肿，1 例非致命性卒中和 1 例肺栓塞）。在校正基线 RCRI 评分后，DSE 异常结果（OR，6.08，95%CI，2.41 至 15.31，P<0.001）、CTA 显示显著 CAD（OR，18.79；95%CI，5.24 至 67.42，P<0.001）和高 CACS（OR，4.19；95%CI，1.39 至 12.60，P=0.011）仍然是围手术期 CV 事件的独立预测因素。