Kato Takao, Uemura Yukari, Naya Masanao, Matsumoto Naoya, Momose Mitsuru, Hida Satoshi, Yamauchi Takao, Nakajima Takatomo, Suzuki Eriko, Inoko Moriaki, Shiga Tohru, Tamaki Nagara
Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan
Department of Data Science, National Center for Global Health and Medicine Hospital, Shinjuku-ku, Tokyo, Japan.
BMJ Open. 2020 Sep 6;10(9):e035111. doi: 10.1136/bmjopen-2019-035111.
We aimed to evaluate the association of the prognostic impact of coronary revascularisation with physician-referred non-invasive diagnostic imaging tests (single photon emission CT (SPECT) vs coronary CT angiography) for coronary artery disease.
A post hoc analysis of a subgroup from the patient cohort recruited for the Japanese Coronary-Angiography or Myocardial Imaging for Angina Pectoris Study.
Multiple centres in Japan.
From the data of 2780 patients with stable angina, enrolled prospectively between January 2006 and March 2008 in Japan, who had undergone physician-referred non-invasive imaging tests, 1205 patients with SPECT as an initial strategy and 625 with CT as an initial strategy were analysed. We assessed the effect of revascularisation (within 90 days) in each diagnostic imaging stratum and the interaction between the two strata.
Major adverse cardiac events (MACEs), including death, myocardial infarction, hospitalisation for heart failure and late revascularisation, were followed up for 1 year. The χ test, Student's t-test, Kaplan-Meier analysis, log-rank test and multivariable Cox proportional hazard model were used in data analysis.
A total of 210 (17.4%) patients in the SPECT stratum and 149 (23.8%) in the CT stratum underwent revascularisation. Although in each stratum, the cumulative 1 year incidence of MACEs was significantly higher in patients who underwent revascularisation than in those who did not (SPECT stratum: 9.1 vs 1.2%, log-rank p<0.0001; CT stratum: 6.1 vs 0.8%, log-rank p=0.0001), there was no interaction between the risk of revascularisation and the imaging strata (SPECT stratum: adjusted HR (95% CI), 4.25 (1.86-9.72); CT stratum: 4.13 (1.16-14.73); interaction: p=0.97).
The association of revascularisation with the outcomes of patients with suspected coronary artery disease was not different between SPECT-first and CT-first strategies in a physician-referred fashion.
我们旨在评估冠状动脉血运重建的预后影响与医生推荐的用于冠心病的非侵入性诊断成像检查（单光子发射计算机断层扫描（SPECT）与冠状动脉CT血管造影）之间的关联。
对为日本心绞痛冠状动脉造影或心肌成像研究招募的患者队列中的一个亚组进行事后分析。
日本的多个中心。
从2006年1月至2008年3月在日本前瞻性纳入的2780例稳定型心绞痛患者的数据中，分析了1205例以SPECT作为初始策略和625例以CT作为初始策略且接受了医生推荐的非侵入性成像检查的患者。我们评估了每个诊断成像层中血运重建（90天内）的效果以及两层之间的相互作用。
对主要不良心脏事件（MACE）进行为期1年的随访，包括死亡、心肌梗死、因心力衰竭住院和晚期血运重建。数据分析采用χ检验、学生t检验、Kaplan-Meier分析、对数秩检验和多变量Cox比例风险模型。
SPECT层共有210例（17.4%）患者和CT层149例（23.8%）患者接受了血运重建。尽管在每层中，接受血运重建的患者1年MACE累积发生率显著高于未接受血运重建的患者（SPECT层：9.1%对1.2%，对数秩p<0.0001；CT层：6.1%对0.8%，对数秩p = 0.0001），但血运重建风险与成像层之间没有相互作用（SPECT层：调整后HR（95%CI），4.25（1.86 - 9.72）；CT层：4.13（1.16 - 14.73）；相互作用：p = 0.97）。
在医生推荐的方式下，以SPECT优先和CT优先策略进行冠状动脉血运重建与疑似冠心病患者的结局之间的关联没有差异。
