Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA; Division of Cardiology, Department of Medicine, University of California-Los Angeles, Los Angeles, California, USA.
Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada.
JACC Cardiovasc Imaging. 2021 Mar;14(3):644-653. doi: 10.1016/j.jcmg.2020.05.039. Epub 2020 Aug 19.
Using a contemporary, multicenter international single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) registry, this study characterized the potential major adverse cardiovascular event(s) (MACE) benefit of early revascularization based on automatic quantification of ischemia.
Prior single-center data reported an association between moderate to severe ischemia SPECT-MPI and reduced cardiac death with early revascularization.
Consecutive patients from a multicenter, international registry who underwent Tc SPECT-MPI between 2009 and 2014 with solid-state scanners were included. Ischemia was quantified automatically as ischemic total perfusion deficit (TPD). Early revascularization was defined as within 90 days. The primary outcome was MACE (death, myocardial infarction, and unstable angina). A propensity score was developed to adjust for nonrandomization of revascularization; then, multivariable Cox modeling adjusted for propensity score and demographics was used to predict MACE.
In total, 19,088 patients were included, with a mean follow-up of 4.7 ± 1.6 years, during which MACE occurred in 1,836 (9.6%) patients. There was a significant interaction between ischemic TPD modeled as a continuous variable and early revascularization (interaction p value: 0.012). In this model, there was a trend toward reduced MACE in patients with >5.4% ischemic TPD and a significant association with reduced MACE in patients with >10.2% ischemic TPD.
In this large, international, multicenter study reflecting contemporary cardiology practice, early revascularization of patients with >10.2% ischemia on SPECT-MPI, quantified automatically, was associated with reduced MACE.
利用当代多中心国际单光子发射计算机断层心肌灌注成像（SPECT-MPI）注册研究，本研究基于自动定量缺血来描述早期血运重建的潜在主要不良心血管事件（MACE）获益。
先前的单中心数据报告称，SPECT-MPI 中存在中重度缺血与早期血运重建后降低的心脏死亡相关。
本研究纳入了来自一个多中心、国际注册研究的连续患者，这些患者在 2009 年至 2014 年间接受了 Tc SPECT-MPI 检查，使用的是固态扫描仪。缺血通过自动定量计算为缺血总灌注缺损（TPD）。早期血运重建定义为 90 天内。主要结局是 MACE（死亡、心肌梗死和不稳定型心绞痛）。制定了倾向评分来调整血运重建的非随机性；然后，使用多变量 Cox 模型调整倾向评分和人口统计学因素来预测 MACE。
共纳入 19088 例患者，平均随访 4.7±1.6 年，在此期间 1836 例（9.6%）患者发生了 MACE。缺血 TPD 连续变量与早期血运重建之间存在显著交互作用（交互 p 值：0.012）。在该模型中，TPD＞5.4%的患者发生 MACE 的风险降低，TPD＞10.2%的患者发生 MACE 的风险显著降低。
在这项反映当代心脏病学实践的大型国际多中心研究中，SPECT-MPI 自动定量存在＞10.2%缺血的患者进行早期血运重建与 MACE 降低相关。
