Tang Li-Hua, Huang Yih-Hwen, Chen Chien-Jung, Yen Ruoh-Fang, Tsai Min-Hsuan, Chen Chia-Hui Cheryl
MSN, RN, Department of Nuclear Medicine, National Taiwan University Hospital, Taiwan, ROC.
MS, Chief Technology Officer, Department of Nuclear Medicine, National Taiwan University Hospital, Taiwan, ROC.
Hu Li Za Zhi. 2022 Jun;69(3):58-67. doi: 10.6224/JN.202206_69(3).09.
Myocardial perfusion imaging (MPI) is the method most commonly used to assess patients with suspected coronary artery disease for the presence of myocardial ischemia and risk of subsequent adverse cardiac events. Studies are limited on the incidence of major adverse cardiac event (MACE) in patients with normal MPI results.
The aim of this study was to investigate the incidence and risk factors of MACE in patients with normal or near-normal MPI results.
In this single-center retrospective chart review study, patients who had received MPI tests at a nuclear medicine department of a medical center in 2017 were consecutively enrolled. All of the participants in this study were patients with normal or near-normal MPI results, and were followed for two years to assess the incidence of MACE (death, hospitalized for percutaneous coronary intervention; CABG, heart failure and stroke). Participants with or without MACE were compared to determine whether demographic, comorbidity, and MPI data were significant risk factors.
Of the 1,629 participants (age = 70.4 ± 11.3 years, 49.4% male) enrolled, 387 (23.8%) were classified into the normal MPI group and 1,242 (76.2%) were classified into the near-normal MPI group. Notably, 61 participants (15.8%) in the normal MPI group and 206 (16.6%) in the near-normal MPI group experienced MACE events during the two-year follow-up. The risk factors of MACE identified in this study included being older in age, being male, and having poor myocardial perfusion parameters (i.e., ejection fraction) during MPI.
CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Over the two-year study period, 15.8% of the participants with normal MPI results and 16.6% of those with near-normal MPI results experienced major adverse cardiac events. Thus, it is critical to inform patients regarding the potential risk of MACE risk and to educate them on how to mitigate this risk by actively managing their hyperlipidemia level and left ventricular ejection fraction.
心肌灌注成像（MPI）是评估疑似冠状动脉疾病患者是否存在心肌缺血及后续发生不良心脏事件风险时最常用的方法。关于MPI结果正常的患者发生主要不良心脏事件（MACE）的发生率的研究有限。
本研究旨在调查MPI结果正常或接近正常的患者中MACE的发生率及危险因素。
在这项单中心回顾性病历审查研究中，连续纳入2017年在某医疗中心核医学科接受MPI检查的患者。本研究的所有参与者均为MPI结果正常或接近正常的患者，并随访两年以评估MACE（死亡、因经皮冠状动脉介入治疗住院；冠状动脉旁路移植术、心力衰竭和中风）的发生率。比较发生或未发生MACE的参与者，以确定人口统计学、合并症和MPI数据是否为显著危险因素。
在纳入的1629名参与者（年龄=70.4±11.3岁，49.4%为男性）中，387名（23.8%）被归类为MPI正常组，1242名（76.2%）被归类为MPI接近正常组。值得注意的是，在两年的随访期间，MPI正常组中有61名参与者（15.8%），MPI接近正常组中有206名参与者（16.6%）发生了MACE事件。本研究确定的MACE危险因素包括年龄较大、男性以及MPI期间心肌灌注参数（即射血分数）较差。
结论/对实践的启示：在为期两年的研究期间，MPI结果正常的参与者中有15.8%，MPI结果接近正常的参与者中有16.6%发生了主要不良心脏事件。因此，告知患者MACE风险的潜在风险，并教育他们如何通过积极控制血脂水平和左心室射血分数来降低这种风险至关重要。
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