Santana-Boado C, Figueras J, Candell-Riera J, Bermejo B, Cortadellas J, Castell J, Aguadé S, Soler-Soler J
Servicio de Cardiología, Hospital General Universitari Vall d'Hebron, Barcelona.
Rev Esp Cardiol. 1998 Apr;51(4):297-301. doi: 10.1016/s0300-8932(98)74748-7.
Although different reports have compared the extent of the myocardial ischemia in patients with or without angina during exercise test, there have been few publications which have studied their prognosis. The aim of this study is to analyze the prognostic value of the presence of angina during 99mTc-MIBI SPECT in patients with proven coronary artery disease without previous myocardial infarction.
We studied 82 patients prospectively with at least one coronary stenosis > 70% and with reversible perfusion defects in 99mTc-MIBI SPECT (long protocol). Twenty two of these patients had angina during exercise test. The extension of ischemia was quantified on SPECT and the severity of coronary stenoses on coronary angiography. The mean follow-up period was 3.2 years.
The angina patients showed a significantly lower coronary reserve (exercise duration: 6.3 min vs 8 min; p = 0.03), a lower maximal O2 consumption (5.8 METs vs 6.2 METs; p = 0.04), a higher rate of ST depression > 1 mm (64% vs 19%; p = 0.006) and a higher degree of ST depression (0.9 mm vs 0.4 mm; p = 0.01) than those patients without angina. There were no significant differences in the extent of ischemia in SPECT or in the angiographic severity of coronary disease between either groups. During the follow-up period the presence of severe complications (myocardial infarction or death) tended to be higher (27% vs 17%; NS) in patients with angina and the indication of surgical revascularization was also significantly higher (50% vs 17%; p = 0.002) in this group.
Presence of angina during 99mTc-MIBI SPECT portends a higher risk of medium and long term complications, mainly due to surgical revascularization.
尽管不同报告比较了运动试验中有或无心绞痛患者的心肌缺血程度，但很少有研究其预后的出版物。本研究的目的是分析99mTc-MIBI单光子发射计算机断层扫描（SPECT）时心绞痛的存在对确诊为冠心病且既往无心肌梗死患者的预后价值。
我们前瞻性研究了82例至少有一处冠状动脉狭窄>70%且99mTc-MIBI SPECT（长方案）中有可逆性灌注缺损的患者。其中22例患者在运动试验时有心绞痛。在SPECT上对缺血范围进行量化，在冠状动脉造影上对冠状动脉狭窄程度进行量化。平均随访期为3.2年。
与无心绞痛的患者相比，心绞痛患者的冠状动脉储备显著更低（运动持续时间：6.3分钟对8分钟；p = 0.03），最大耗氧量更低（5.8代谢当量对6.2代谢当量；p = 0.04），ST段压低>1毫米的发生率更高（64%对19%；p = 0.006），ST段压低程度更高（0.9毫米对0.4毫米；p = 0.01）。两组在SPECT上的缺血范围或冠状动脉疾病的血管造影严重程度方面无显著差异。在随访期间，心绞痛患者发生严重并发症（心肌梗死或死亡）的倾向更高（27%对17%；无显著性差异），并且该组中手术血运重建的指征也显著更高（50%对17%；p = 0.002）。
99mTc-MIBI SPECT时心绞痛的存在预示着中、长期并发症的风险更高，主要是由于手术血运重建。
