Di Carli M F, Maddahi J, Rokhsar S, Schelbert H R, Bianco-Batlles D, Brunken R C, Fromm B
Division of Nuclear Medicine, Department of Medical and Molecular Pharmacology, UCLA School of Medicine, Los Angeles, CA, USA.
J Thorac Cardiovasc Surg. 1998 Dec;116(6):997-1004. doi: 10.1016/S0022-5223(98)70052-2.
Our purpose was to evaluate the long-term benefit of myocardial viability assessment for stratifying risk and selecting patients with low ejection fraction for coronary artery bypass grafting and to determine the relation between the severity of anginal symptoms, the amount of ischemic myocardium, and clinical outcome.
We studied 93 consecutive patients with severe coronary artery disease and low ejection fraction (median, 25%) who underwent positron emission tomography to delineate the extent of perfusion-metabolism mismatch (reflecting hibernating myocardium) for potential myocardial revascularization. Median follow-up was 4 years (range, 0 to 6.2 years).
Fifty patients received medical therapy, and 43 patients underwent bypass grafting. In Cox survival models, heart failure class, prior myocardial infarction, and positron emission tomographic mismatch were the best predictors of survival. Patients with positron emission tomographic mismatch receiving bypass grafting had improved 4-year survival compared with those on medical therapy (75% versus 30%; P =.007) and a significant improvement in angina and heart failure symptoms. In patients without positron emission tomographic mismatch, bypass grafting tended to improve survival and symptoms only in those patients with severe angina (100% versus 60%; P =.085), whereas no survival advantage was apparent in patients with minimal or no anginal symptoms (63% versus 52%; P =.462).
Patients with low ejection fraction and evidence of viable myocardium by positron emission tomography have improved survival and symptoms with coronary bypass grafting compared with medical therapy. In patients without evidence of viability, survival and symptom improvement with bypass grafting are apparent only among those patients with severe angina.
我们的目的是评估心肌存活性评估对于风险分层以及选择低射血分数患者进行冠状动脉搭桥术的长期益处，并确定心绞痛症状严重程度、缺血心肌量与临床结局之间的关系。
我们研究了93例连续的严重冠状动脉疾病且低射血分数（中位数为25%）的患者，这些患者接受了正电子发射断层扫描以描绘灌注-代谢不匹配（反映冬眠心肌）的范围，用于潜在的心肌血运重建。中位随访时间为4年（范围为0至6.2年）。
50例患者接受药物治疗，43例患者接受搭桥手术。在Cox生存模型中，心力衰竭分级、既往心肌梗死和正电子发射断层扫描不匹配是生存的最佳预测因素。接受搭桥手术的正电子发射断层扫描不匹配患者与接受药物治疗的患者相比，4年生存率有所提高（75%对30%；P = 0.007），心绞痛和心力衰竭症状有显著改善。在没有正电子发射断层扫描不匹配的患者中，搭桥手术仅在那些严重心绞痛患者中倾向于提高生存率和改善症状（100%对60%；P = 0.085），而在轻微或无心绞痛症状的患者中没有明显的生存优势（63%对52%；P = 0.462）。
与药物治疗相比，低射血分数且通过正电子发射断层扫描有存活心肌证据的患者接受冠状动脉搭桥术可提高生存率并改善症状。在没有存活证据的患者中，搭桥手术对生存率和症状的改善仅在那些严重心绞痛患者中明显。
