Amanullah A M, Kiat H, Hachamovitch R, Cabico J A, Cohen I, Friedman J D, Berman D S
Department of Imaging (Division of Nuclear Medicine), Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
J Am Coll Cardiol. 1996 Sep;28(3):680-6. doi: 10.1016/0735-1097(96)00200-8.
This study sought to assess the impact of myocardial perfusion studies on subsequent management in the very elderly with respect to referral to catheterization or revascularization.
The very elderly are a rapidly growing segment of the U.S. population, and myocardial perfusion studies are frequently performed in this patient subset for evaluation of coronary artery disease.
The study utilized 1,006 consecutive patients > or = 80 years old (511 men, 495 women) who underwent stress myocardial perfusion single-photon emission computed tomography (SPECT) using pharmacologic stress (n = 605) or treadmill exercise (n = 401). Referral to catheterization or revascularization within 60 days of the nuclear scan was correlated with clinical and nuclear variables.
Catheterization and revascularization were performed in 119 and 77 patients, respectively. Stratification of referral rates showed a low rate in normal and mildly abnormal scan categories and significantly higher rates in patients with severely abnormal scan results irrespective of the presenting symptoms or pretest likelihood of coronary artery disease. Multiple logistic regression analysis of clinical and nuclear variables revealed that extent and severity of reversibility by SPECT and the final scan result were the two most powerful predictors of referral to catheterization and revascularization in men and women (catheterization: chi-square 65 and 78; revascularization: chi-square 37 and 68, respectively). Overall, referral rates to catheterization and revascularization were similar in men and women (catheterization: 13% vs. 11%; revascularization: 8% vs. 8%, respectively). However, women with severely abnormal scan results were more frequently referred to catheterization (28% vs. 18%, p < 0.03) and revascularization (21% vs. 12%, p < 0.01) than men.
In patients > or = 80 years old, myocardial perfusion SPECT had a significant impact on patient management. The apparent discrepancy in referral rates for interventional management in men and women is unexplained but may be appropriate in light of our previous observations that women with severely abnormal scan results are at increased risk for hard cardiac events than are men with severely abnormal scan results.
本研究旨在评估心肌灌注研究对高龄患者后续治疗管理（涉及导管插入术或血运重建转诊）的影响。
高龄人群在美国人口中所占比例迅速增长，心肌灌注研究常在这一患者亚组中进行，用于评估冠状动脉疾病。
该研究纳入了1006例年龄≥80岁的连续患者（511例男性，495例女性），这些患者接受了负荷心肌灌注单光子发射计算机断层扫描（SPECT），其中使用药物负荷的有605例，使用平板运动负荷的有401例。核素扫描后60天内进行导管插入术或血运重建转诊与临床及核素变量相关。
分别有119例和77例患者进行了导管插入术和血运重建。转诊率分层显示，扫描结果正常和轻度异常的类别中比率较低，而扫描结果严重异常的患者比率显著更高，无论其当前症状或冠状动脉疾病的检查前可能性如何。对临床和核素变量进行的多因素逻辑回归分析显示，SPECT的可逆性范围和严重程度以及最终扫描结果是男性和女性转诊进行导管插入术和血运重建的两个最有力预测因素（导管插入术：卡方值分别为65和78；血运重建：卡方值分别为37和68）。总体而言，男性和女性的导管插入术和血运重建转诊率相似（导管插入术：分别为13%和11%；血运重建：分别为8%和8%）。然而，扫描结果严重异常的女性比男性更频繁地被转诊进行导管插入术（28%对18%，p<0.03）和血运重建（21%对12%，p<0.01）。
在年龄≥80岁的患者中，心肌灌注SPECT对患者管理有显著影响。男性和女性介入治疗转诊率的明显差异尚无合理解释，但鉴于我们之前的观察结果，即扫描结果严重异常的女性比扫描结果严重异常的男性发生严重心脏事件的风险更高，这一差异可能是合理的。
