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首页> 外文期刊>Journal of nuclear cardiology: official publication of the American Society of Nuclear Cardiology >Prognostic value of stress-gated 99m-technetium SPECT myocardial perfusion imaging: Risk stratification of patients with multivessel coronary artery disease and prior coronary revascularization
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Prognostic value of stress-gated 99m-technetium SPECT myocardial perfusion imaging: Risk stratification of patients with multivessel coronary artery disease and prior coronary revascularization

机译：应力门控99m SP SPECT心肌灌注显像的预后价值：多支冠状动脉疾病和既往冠状动脉血运重建患者的危险分层

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Background: This study assessed the prognostic value of stress-gated 99mTc-sestamibi myocardial perfusion SPECT (MPS) in patients with multivessel coronary artery disease (CAD) and prior revascularization according to the presence and severity of ischemia. Methods and Results: We studied the outcome of 472 patients with multivessel CAD and prior revascularization (coronary angioplasty, 290 patients; bypass surgery, 182 patients), who underwent exercise or dipyridamole 99mTc-sestamibi MPS for evaluation of ischemia. Visual scoring of perfusion images used 20 segments and a 5-point scale. Gated post-stress EF was automatically calculated. Endpoints included hard events: cardiac death (CD) and nonfatal myocardial infarction (MI). During a mean follow-up of 3.0 ± 1.0 years, 37 hard events occurred, including CD in 15 (3%) and MI in 22 (5%) patients. In a risk-adjusted multivariable Cox model, a history of prior MI, diabetes, abnormal MPS, moderate-to-severe ischemia, and post-stress EF <35% were important predictors of cardiac events. Four-year risk-adjusted survival was 97.9% for normal MPS, 87.3% for abnormal MPS with ischemia, and 82.1% for moderate-to-severe ischemia. Conclusions: Among patients with previous coronary revascularization, stress-gated 99mTc-sestamibi MPS provides prognostic information for the prediction of cardiac events. A normal perfusion scan confers an excellent prognosis and an exceedingly low hard event rate (<1%/year). The presence of moderate-to-severe ischemia or a post-stress EF <35% identifies patients at highest risk of subsequent cardiac events.
机译：背景：本研究根据缺血的存在和严重程度评估了应力门控99mTc-司他他比心肌灌注SPECT（MPS）对多支冠状动脉疾病（CAD）和事先血运重建患者的预后价值。方法和结果：我们研究了472例多血管CAD并事先血运重建的患者（冠状动脉血管成形术，290例;旁路手术，182例）的结果，他们接受了运动或双嘧达莫99mTc-西他米比MPS评估缺血性。灌注图像的视觉评分使用20段和5分制。门控后应力EF是自动计算的。终点包括硬事件：心源性死亡（CD）和非致命性心肌梗塞（MI）。在平均3.0±1.0年的随访期间，发生了37例硬事件，包括15例（3％）的CD和22例（5％）的MI。在经过风险调整的多变量Cox模型中，先前心梗，糖尿病，MPS异常，中度至重度缺血以及应激后EF <35％的病史是心脏事件的重要预测指标。正常MPS的四年风险调整后生存率为97.9％，患有局部缺血的异常MPS为87.3％，中至重度缺血为82.1％。结论：在先前有冠状动脉血运重建的患者中，应力门控的99mTc-sestamibi MPS可为预测心脏事件提供预后信息。正常的灌注扫描可以提供良好的预后和极低的硬事件发生率（<1％/年）。中度至重度缺血或压力后EF <35％的存在表明患者发生后续心脏事件的风险最高。

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