Lauer M S, Pashkow F J, Snader C E, Harvey S A, Thomas J D, Marwick T H
Department of Cardiology, Cleveland Clinic Foundation, OH 44195, USA.
Am Heart J. 1997 Feb;133(2):139-46. doi: 10.1016/s0002-8703(97)70201-1.
This study investigated the association between age and referral to coronary angiography among ambulatory adults with an abnormal treadmill thallium scan. The subjects studied were 416 consecutive adults who were > or = 30 years old, under the care of cardiologists, and had an abnormal treadmill thallium scan between 1990 and 1993 at the Cleveland Clinic Foundation. The primary end point was performance of coronary angiography within 90 days of the treadmill test. Coronary angiography was performed in 163 subjects. Coronary angiography was performed in 46% of patients aged 30-49 years, in 53% of those aged 50 to 64 years, in 33% of those aged 65 to 74 years, and in only 18% of those aged > or = 75 years (chi2 test for trend, p < 0.0001). After adjustment for potential confounders, age remained associated with a lower rate of referral to angiography (p < 0.0001). During 2 years of follow-up 34 deaths occurred (14 cardiac), with particularly high mortality rates among those aged >74 years (cumulative rate 31%, 95% confidence interval 16% to 47%). The number of abnormal thallium scan segments was predictive of death (p = 0.02). These data suggest that increasing age is associated with a lower rate of referral to coronary angiography after an abnormal treadmill thallium test.
本研究调查了门诊成年人心电图运动铊扫描异常时年龄与冠状动脉造影转诊之间的关联。研究对象为416名连续入选的成年人，年龄≥30岁，由心脏病专家诊治，于1990年至1993年在克利夫兰诊所基金会进行了异常的心电图运动铊扫描。主要终点是在运动试验后90天内进行冠状动脉造影。163名受试者进行了冠状动脉造影。30至49岁患者中46%进行了冠状动脉造影，50至64岁患者中53%进行了造影，65至74岁患者中33%进行了造影，而≥75岁患者中只有18%进行了造影（趋势χ2检验，p<0.0001）。在对潜在混杂因素进行校正后，年龄仍然与较低的冠状动脉造影转诊率相关（p<0.0001）。在2年的随访期间，发生了34例死亡（14例心脏相关死亡），74岁以上人群的死亡率特别高（累积死亡率31%，95%置信区间为16%至47%）。铊扫描异常节段数可预测死亡（p=0.02）。这些数据表明，年龄增加与心电图运动铊试验异常后较低的冠状动脉造影转诊率相关。
