Pavin D, Delonca J, Siegenthaler M, Doat M, Rutishauser W, Righetti A
Cardiology Center, University Hospital, Geneva, Switzerland.
Eur Heart J. 1997 Jan;18(1):69-77. doi: 10.1093/oxfordjournals.eurheartj.a015120.
In order to assess the prognostic significance of normal exercise thallium-210 myocardial scintigraphy in patients with documented coronary artery disease, we studied the incidence of cardiac death and non-fatal myocardial infarction in 69 symptomatic patients without prior Q wave myocardial infarction, who demonstrated one or more significant coronary lesions (stenosis > or = 70%) on an angiogram performed within 3 months of scintigraphy (Group 1). These patients were compared to a second group of 136 patients with an abnormal exercise scintigram, defined by the presence of reversible defect(s) and angiographically proven coronary artery disease (Group 2), and to a third group of 102 patients with normal exercise scintigraphy without significant coronary lesions (stenosis < or = 30%) or with normal coronary angiography (Group 3). In contrast to coronary lesions observed in Group 2, patients in Group 1 presented more frequently with single-vessel disease (83% vs 35%, P < 0.0001) and with more distal lesions (55% vs 23%, P < 0.0001). Over a mean follow-up period of 8.6 years, one fatal and eight non-fatal cases of myocardial infarction were observed in Group 1. The majority of patients in Group 1 were treated medically: only 24 (35%) underwent myocardial revascularization, usually by coronary angioplasty. There was no significant difference in the incidence of combined major cardiac events (cardiac death, non-fatal myocardial infarction) in patients with normal exercise scintigraphy, with or without documented coronary artery disease (Groups 1 and 3), while the incidence was higher in Group 2. However, while the mortality remained very low in Group 1, the incidence of non-fatal myocardial infarction was not different from that of Group 2, where most patients underwent revascularization procedures. In conclusion, patients with coronary artery disease and a normal exercise thallium-201 myocardial scintigram usually have mild coronary lesions (single-vessel disease, distal location) and good long-term prognosis, with a low incidence of cardiac death.
为了评估正常运动铊-201心肌闪烁显像对已确诊冠心病患者的预后意义，我们研究了69例有症状且既往无Q波心肌梗死患者的心源性死亡和非致命性心肌梗死发生率。这些患者在闪烁显像后3个月内进行的血管造影显示有一个或多个明显的冠状动脉病变（狭窄≥70%）（第1组）。将这些患者与第二组136例运动闪烁显像异常的患者进行比较，运动闪烁显像异常定义为存在可逆性缺损且血管造影证实有冠状动脉疾病（第2组），还与第三组102例运动闪烁显像正常且无明显冠状动脉病变（狭窄≤30%）或冠状动脉造影正常的患者进行比较（第3组）。与第2组观察到的冠状动脉病变相比，第1组患者单支血管病变更为常见（83%对35%，P<0.0001），且远端病变更多（55%对23%，P<0.0001）。在平均8.6年的随访期内，第1组观察到1例致命性和8例非致命性心肌梗死病例。第1组的大多数患者接受药物治疗：只有24例（35%）接受了心肌血运重建，通常是通过冠状动脉成形术。运动闪烁显像正常的患者，无论有无确诊的冠状动脉疾病（第1组和第3组），联合主要心脏事件（心源性死亡、非致命性心肌梗死）的发生率无显著差异，而第2组的发生率更高。然而，虽然第1组的死亡率仍然很低，但非致命性心肌梗死的发生率与第2组没有差异，第2组的大多数患者接受了血运重建手术。总之，冠心病患者且运动铊-201心肌闪烁显像正常通常有轻度冠状动脉病变（单支血管病变、远端病变）和良好的长期预后，心源性死亡发生率低。
