双嘧达莫-铊-201心肌闪烁显像用于无并发症心肌梗死后患者的早期危险分层

Dipyridamole thallium-201 scintigraphy for early risk stratification of patients after uncomplicated myocardial infarction.

作者信息

Hung J, Moshiri M, Groom G N, Van der Schaaf A A, Parsons R W, Hands M E

机构信息

Department of Medicine, University of Western Australia, Perth, Australia.

出版信息

Heart. 1997 Oct;78(4):346-52. doi: 10.1136/hrt.78.4.346.

DOI:10.1136/hrt.78.4.346

PMID:9404249

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1892252/

Abstract

OBJECTIVE

To determine the safety and prognostic value of dipyridamole thallium-201 scintigraphy performed in patients within three to five days of acute myocardial infarction, including those receiving thrombolytic treatment.

DESIGN

A prospective study of dipyridamole thallium-201 scintigraphy in patients early after acute myocardial infarction.

SETTING

University hospital.

PATIENTS

200 patients who were clinically uncomplicated at day 3 after infarction, 92 (46%) of whom had received thrombolysis.

MAIN OUTCOME MEASURES

Incidence of cardiac death, non-fatal reinfarction, readmission to hospital for unstable angina, or non-elective revascularisation procedure within six months' follow up.

RESULTS

No patient had a serious complication from the dipyridamole study. At six month follow up, 55 patients (28%) had suffered a defined cardiac event. Patients who received thrombolysis had the same extent of thallium-201 redistribution and the same occurrence of subsequent cardiac events as those not receiving thrombolysis. Patients who subsequently had an event had more myocardial segments showing thallium-201 redistribution than event free patients: 2.7 (SD 1.9) v 1.2 (1.4), respectively (p < 0.001). Among all clinical and scintigraphic variables, multivariate analysis identified the extent of thallium-201 redistribution as the only independent predictor of outcome (p < 0.001). Among 63 patients (32%) of the study cohort who showed more than two myocardial segments with thallium-201 redistribution, the adjusted risk ratio for a cardiac event was 7.5 (95% confidence interval 2.9 to 19.1) compared with patients without any redistribution.

CONCLUSIONS

Dipyridamole thallium-201 scintigraphy can be performed safely within a few days of the event in patients with uncomplicated myocardial infarction, including those who received thrombolysis, and can identify a subgroup of patients at high risk of future ischaemic events.

摘要

目的

确定在急性心肌梗死三至五天内（包括接受溶栓治疗的患者）进行双嘧达莫铊-201心肌灌注显像的安全性和预后价值。

设计

对急性心肌梗死后早期患者进行双嘧达莫铊-201心肌灌注显像的前瞻性研究。

地点

大学医院。

患者

200例梗死第3天临床无并发症的患者，其中92例（46%）接受了溶栓治疗。

主要观察指标

随访6个月内心脏死亡、非致死性再梗死、因不稳定型心绞痛再次入院或非择期血运重建手术的发生率。

结果

双嘧达莫检查未使任何患者出现严重并发症。随访6个月时，55例患者（28%）发生了明确的心脏事件。接受溶栓治疗的患者与未接受溶栓治疗的患者铊-201再分布程度相同，随后发生心脏事件的情况也相同。随后发生事件的患者比未发生事件的患者有更多显示铊-201再分布的心肌节段：分别为2.7（标准差1.9）和1.2（1.4）（p<0.001）。在所有临床和显像变量中，多因素分析确定铊-201再分布程度是唯一独立的预后预测因素（p<0.001）。在研究队列中63例（32%）显示有两个以上心肌节段铊-201再分布的患者中，与无任何再分布的患者相比，心脏事件的校正风险比为7.5（95%置信区间2.9至19.1）。