Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-Cho, Kamigyo-Ku, Kyoto, 602-8026, Japan.
Department of Functional Imaging and Artificial Intelligence, Kanazawa University, Kanazawa, Japan.
Ann Nucl Med. 2021 Feb;35(2):241-252. doi: 10.1007/s12149-020-01558-4. Epub 2021 Jan 3.
An assessment of cardiac events and survival using quantitative gated myocardial single-photon emission computed tomography (SPECT) (J-ACCESS) associated several risk factors with cardiac events in Japan. The clinical course after revascularization and/or optimal medical therapy (OMT) was followed in patients with coronary artery disease (CAD) at moderate-to-high risk estimated by software incorporating the J-ACCESS risk model. The present study aimed to determine the relevance of changes in estimated risk to outcomes of these therapies.
This study included 494 patients with possible or definite CAD who underwent initial pharmacological stress Tc-tetrofosmin myocardial perfusion SPECT (MPS) before and eight months after therapy. Major cardiac event risk during 3 years of follow-up was calculated using an equation based on that in the J-ACCESS study. Patients with ≥ 10% cardiac event risk estimated at the first MPS (n = 31) were analyzed and followed up for at least 1 year.
Estimated risk was reduced by ≥ 5% in 14 patients (45%) after therapy. During a follow-up period of 22.1 ± 6.7 months, one patient without such reduction had a major cardiac event. Mean %summed stress scores significantly decreased from baseline to follow-up in patients with and without risk reduction. Left ventricular ejection fraction (LVEF [%]) at rest was significantly increased at the second, compared with the first MPS between patients with, than without risk reduction (57 ± 17 vs. 45 ± 16%, p = 0.001 and 50 ± 11 vs. 49 ± 9%, p = 0.953, respectively).
A reduction in cardiac ischemia and an increase in LVEF by revascularization and/or OMT were necessary to avoid cardiac events among patients with moderate-to-high estimated risk, and changes in event risk were quantifiable.
使用定量门控心肌单光子发射计算机断层扫描（SPECT）（J-ACCESS）评估心脏事件和生存率，结合 J-ACCESS 风险模型，将几个风险因素与日本的心脏事件相关联。软件评估为中高危的冠心病（CAD）患者在接受血运重建和/或最佳药物治疗（OMT）后进行临床随访。本研究旨在确定风险估计值变化与这些治疗结果的相关性。
本研究纳入了 494 例疑似或确诊 CAD 的患者，他们在治疗前和治疗后 8 个月均接受了初始药物负荷铊-四氮茂心肌灌注 SPECT（MPS）检查。根据 J-ACCESS 研究中的方程计算 3 年随访期间的主要心脏事件风险。在首次 MPS 时（n=31）估计有≥10%心脏事件风险的患者进行了分析，并随访至少 1 年。
治疗后，14 例（45%）患者的估计风险降低了≥5%。在 22.1±6.7 个月的随访期间，1 例未发生这种风险降低的患者发生了主要心脏事件。有和无风险降低的患者的平均总和应激评分从基线到随访都显著降低。与无风险降低的患者相比，有风险降低的患者在第二次 MPS 时的静息左心室射血分数（LVEF [%]）显著增加（57±17 比 45±16%，p=0.001 和 50±11 比 49±9%，p=0.953）。
在中高危估计风险的患者中，血运重建和/或 OMT 降低心脏缺血和提高 LVEF 是避免心脏事件的必要条件，并且风险变化是可量化的。
