Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
JACC Cardiovasc Imaging. 2020 Oct;13(10):2193-2202. doi: 10.1016/j.jcmg.2020.03.022. Epub 2020 Jun 17.
This study sought to develop a clinical model that identifies a lower-risk population for coronary artery disease that could benefit from stress-first myocardial perfusion imaging (MPI) protocols and that can be used at point of care to risk stratify patients.
There is an increasing interest in stress-first and stress-only imaging to reduce patient radiation exposure and improve patient workflow and experience.
A secondary analysis was conducted on a single-center cohort of patients undergoing single-photon emission computed tomography (SPECT) and positron emission tomography (PET) studies. Normal MPI was defined by the absence of perfusion abnormalities and other ischemic markers and the presence of normal left ventricular wall motion and left ventricular ejection fraction. A model was derived using a cohort of 18,389 consecutive patients who underwent SPECT and was validated in a separate cohort of patients who underwent SPECT (n = 5,819), 1 internal cohort of patients who underwent PET (n=4,631), and 1 external PET cohort (n = 7,028).
Final models were made for men and women and consisted of 9 variables including age, smoking, hypertension, diabetes, dyslipidemia, typical angina, prior percutaneous coronary intervention, prior coronary artery bypass graft, and prior myocardial infarction. Patients with a score ≤1 were stratified as low risk. The model was robust with areas under the curve of 0.684 (95% confidence interval [CI]: 0.674 to 0.694) and 0.681 (95% CI: 0.666 to 0.696) in the derivation cohort, 0.745 (95% CI: 0.728 to 0.762) and 0.701 (95% CI: 0.673 to 0.728) in the SPECT validation cohort, 0.672 (95% CI: 0.649 to 0.696) and 0.686 (95% CI: 0.663 to 0.710) in the internal PET validation cohort, and 0.756 (95% CI: 0.740 to 0.772) and 0.737 (95% CI: 0.716 to 0.757) in the external PET validation cohort in men and women, respectively. Men and women who scored ≤1 had negative likelihood ratios of 0.48 and 0.52, respectively.
A novel model, based on easily obtained clinical variables, is proposed to identify patients with low probability of having abnormal MPI results. This point-of-care tool may be used to identify a population that might qualify for stress-first MPI protocols.
本研究旨在开发一种临床模型，以识别出患有冠心病风险较低的人群，这些人群可能受益于应激优先心肌灌注成像（MPI）方案，并可在床边用于对患者进行风险分层。
人们越来越感兴趣于应激优先和应激单光子发射计算机断层扫描（SPECT）和正电子发射断层扫描（PET）研究。MPI 正常定义为无灌注异常和其他缺血标志物，同时存在正常的左室壁运动和左室射血分数。该模型通过对 18389 例连续接受 SPECT 检查的患者进行二次分析得出，并在接受 SPECT 检查的患者（n=5819）、1 例接受 PET 检查的内部患者队列（n=4631）和 1 例外部 PET 队列（n=7028）中进行了验证。
最终的模型分别针对男性和女性制定，包含 9 个变量，包括年龄、吸烟、高血压、糖尿病、血脂异常、典型心绞痛、经皮冠状动脉介入治疗史、冠状动脉旁路移植术史和心肌梗死史。评分≤1 的患者被划分为低危人群。该模型具有较高的稳健性，在推导队列中的曲线下面积为 0.684（95%置信区间[CI]：0.674 至 0.694）和 0.681（95%CI：0.666 至 0.696），在 SPECT 验证队列中的曲线下面积为 0.745（95%CI：0.728 至 0.762）和 0.701（95%CI：0.673 至 0.728），在内部 PET 验证队列中的曲线下面积为 0.672（95%CI：0.649 至 0.696）和 0.686（95%CI：0.663 至 0.710），在外部 PET 验证队列中的曲线下面积为 0.756（95%CI：0.740 至 0.772）和 0.737（95%CI：0.716 至 0.757），分别在男性和女性中。评分≤1 的男性和女性的阴性似然比分别为 0.48 和 0.52。
提出了一种基于易于获得的临床变量的新型模型，以识别出 MPI 结果异常可能性较低的患者。这种床边工具可能用于识别可能符合应激优先 MPI 方案的人群。
