Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan.
J Cardiol. 2022 Nov;80(5):475-481. doi: 10.1016/j.jjcc.2022.06.012. Epub 2022 Jul 12.
There is an ongoing controversy regarding the necessity of single-photon emission computed tomography (SPECT) for patients with ischemic heart diseases after the publication of the results of the ISCHEMIA trial. We aimed to evaluate the association of the extent of myocardial ischemia with outcomes in patients with suspected coronary artery disease in Japan.
From the data of 2780 patients with stable angina who were enrolled prospectively between January 2006 and March 2008 in Japan and had undergone physician-referred non-invasive imaging tests (Japanese Coronary-Angiography or Myocardial Imaging for Angina Pectoris Study), 1205 patients managed with SPECT were stratified by 10 % myocardial ischemia. Major adverse cardiac events (MACEs), including death, myocardial infarction, hospitalization for heart failure, and late revascularization, were followed-up for 1 year.
Patients with ≥10 % myocardial ischemia (n = 173) were less likely to be women than patients with <10 % myocardial ischemia (n = 1032) and had a significantly higher 1-year cumulative incidence of MACEs (6.9 % vs. 1.8 %, p < 0.0001). After adjusting for confounders, the risk of ≥10 % myocardial ischemia relative to <10 % myocardial ischemia for MACEs remained significant [adjusted hazard ratio (95 % confidence interval), 2.40 (1.09-5.26), p = 0.029]. After adjusting including treatments, the risk of MACEs became insignificant between the ≥10 % myocardial ischemia group and the <10 % myocardial ischemia group [adjusted hazard ratio (95 % confidence interval), 1.04 (0.45-2.45), p = 0.92].
The presence of ≥10 % myocardial ischemia at diagnosis was significantly associated with the 1-year risk for MACEs in Japanese patients with suspected coronary artery disease.
ISCHEMIA 试验结果公布后，对于缺血性心脏病患者是否需要单光子发射计算机断层扫描（SPECT）一直存在争议。我们旨在评估日本疑似冠心病患者心肌缺血程度与结局的相关性。
从 2006 年 1 月至 2008 年 3 月日本前瞻性纳入的 2780 例稳定型心绞痛患者（接受了医生转诊的非侵入性影像学检查，包括日本冠状动脉造影或心绞痛心肌成像研究）的数据中，根据 10%心肌缺血将 1205 例接受 SPECT 检查的患者进行分层。主要不良心脏事件（MACEs）包括死亡、心肌梗死、心力衰竭住院和晚期血运重建，随访 1 年。
与<10%心肌缺血患者（n=1032）相比，≥10%心肌缺血患者（n=173）女性患者更少，1 年 MACEs 累积发生率显著更高（6.9% vs. 1.8%，p<0.0001）。在校正混杂因素后，与<10%心肌缺血相比，≥10%心肌缺血患者发生 MACEs 的风险仍然显著[校正后危险比（95%置信区间），2.40（1.09-5.26），p=0.029]。在校正治疗后，≥10%心肌缺血组和<10%心肌缺血组之间的 MACEs 风险无统计学意义[校正后危险比（95%置信区间），1.04（0.45-2.45），p=0.92]。
在日本疑似冠心病患者中，诊断时存在≥10%心肌缺血与 1 年 MACEs 风险显著相关。
