Milavetz J J, Miller T D, Hodge D O, Holmes D R, Gibbons R J
Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
Am J Cardiol. 1998 Oct 1;82(7):857-61. doi: 10.1016/s0002-9149(98)00492-5.
Strategies to noninvasively evaluate patients after coronary stenting have not been evaluated. To determine the accuracy of single-photon emission computed tomography (SPECT) myocardial perfusion imaging in patients after coronary stenting, 209 patients who had undergone stenting followed by late stress SPECT myocardial perfusion imaging were evaluated. Quantitative coronary angiography was performed in 33 patients following SPECT imaging. SPECT restenosis was defined as a reversible or fixed defect within the stented vascular territory. Angiographic restenosis was examined using 2 definitions: total area narrowing > or =50% or > or =70% of the stent site or stented artery. The SPECT and angiographic findings were concordant in 22 of 33 stented vascular territories using the 50% definition of restenosis and in 29 of 33 stented territories using the 70% definition. Use of the 70% definition of restenosis resulted in improved accuracy of SPECT to detect a significant stenosis in the stented artery. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of SPECT were 95%, 73%, 88%, 89%, and 88% respectively. In patients with positive SPECT scans, the most significant stenosis in the stented artery was outside the stent site in 50% of cases. SPECT imaging appears to be accurate to predict significant stenosis in the stented artery, although the most severe stenosis is frequently distant from the stent site.
尚未对冠状动脉支架置入术后患者进行无创评估的策略进行评估。为了确定单光子发射计算机断层扫描（SPECT）心肌灌注成像在冠状动脉支架置入术后患者中的准确性，对209例接受支架置入术并随后进行晚期负荷SPECT心肌灌注成像的患者进行了评估。在33例患者进行SPECT成像后进行了定量冠状动脉造影。SPECT再狭窄定义为支架血管区域内的可逆性或固定性缺损。使用两种定义检查血管造影再狭窄：支架部位或支架动脉的总面积狭窄≥50%或≥70%。使用50%的再狭窄定义时，33个支架血管区域中有22个的SPECT和血管造影结果一致；使用70%的定义时，33个支架区域中有29个一致。使用70%的再狭窄定义可提高SPECT检测支架动脉严重狭窄的准确性。SPECT的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为95%、73%、88%、89%和88%。在SPECT扫描阳性的患者中，50%的病例中支架动脉最严重的狭窄位于支架部位之外。SPECT成像似乎能够准确预测支架动脉的严重狭窄，尽管最严重的狭窄往往远离支架部位。
