Candell-Riera J, Santana-Boado C, Bermejo B, Castell-Conesa J, Aguadé-Bruix S, Canela T, Soler-Soler J
Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain.
Am J Cardiol. 1998 Dec 1;82(11):1333-8. doi: 10.1016/s0002-9149(98)00637-7.
The aim of this study was to assess the prognosis of medically treated patients with "clandestine" myocardial ischemia (perfusion defect without angina and no ST depression > 1 mm during exercise test) compared to those with silent myocardial ischemia (ST-segment depression > 1 mm, without angina) and those with angina pectoris. One hundred twelve patients without previous myocardial infarction were included. All patients underwent a symptom-limited exercise test on a bicycle ergometer, myocardial perfusion technetium-99m-methoxy-isobutyl-isonitrile single-photon emission computed tomography (SPECT), and coronary angiography. They were classified into 3 groups (angina group, 34 patients; silent group, 20 patients; and the clandestine group, 58 patients). The mean follow-up was 3.6 years (range 6 months to 5.5 years). Patients with clandestine ischemia had a lower scintigraphic and angiographic score than patients with silent ischemia (25+/-8 vs 31+/-9 and 24+/-8 vs 29+/-7, p = 0.008, respectively), but the prognosis was similar. Only angina and severe reversible SPECT defects were predictive for cardiac events: death + myocardial infarction + revascularization. We conclude that in medically treated patients without previous myocardial infarction, angina and severe reversible SPECT defects are predictive for cardiac events only when the need for revascularization is included as a cardiac event.
本研究旨在评估接受药物治疗的“隐匿性”心肌缺血患者（灌注缺损但无心绞痛且运动试验时ST段压低未超过1毫米）与无症状性心肌缺血患者（ST段压低超过1毫米且无心绞痛）以及心绞痛患者相比的预后情况。纳入了112例既往无心肌梗死的患者。所有患者均接受了症状限制的自行车测力计运动试验、心肌灌注锝-99m-甲氧基异丁基异腈单光子发射计算机断层扫描（SPECT）以及冠状动脉造影。他们被分为3组（心绞痛组，34例患者；无症状组，20例患者；隐匿组，58例患者）。平均随访时间为3.6年（范围为6个月至5.5年）。隐匿性缺血患者的闪烁扫描和血管造影评分低于无症状性缺血患者（分别为25±8 vs 31±9和24±8 vs 29±7，p = 0.008），但预后相似。只有心绞痛和严重可逆性SPECT缺损可预测心脏事件：死亡+心肌梗死+血运重建。我们得出结论，在既往无心肌梗死且接受药物治疗的患者中，仅当将血运重建需求作为心脏事件纳入时，心绞痛和严重可逆性SPECT缺损才是心脏事件的预测指标。
