Prognostic value of stress myocardial perfusion positron emission tomography: results from a multicenter observational registry.
Prognostic value of stress myocardial perfusion positron emission tomography: results from a multicenter observational registry.
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DOI：
10.1016/j.jacc.2012.09.043
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发表时间：
2013-01-15
影响因子：
24
通讯作者：
Shaw, Leslee J.
中科院分区：
文献类型：
--
作者：
Dorbala, Sharmila;Di Carli, Marcelo F.;Beanlands, Rob S.;Merhige, Michael E.;Williams, Brent A.;Veledar, Emir;Chow, Benjamin J. W.;Min, James K.;Pencina, Michael J.;Berman, Daniel S.;Shaw, Leslee J.
这项多中心注册的主要目标是研究PET MPI的预后价值以及在一大批疑似或已知冠心病(CAD)患者中改进的风险分类。正电子发射断层扫描(PET)心肌灌注成像(MPI)的预后数据有限。来自4个中心的7,061名患者接受了临床指示的静息/应激-82PET MPI，中位随访时间为2.2年。这项研究的主要结果是心源性死亡(169名患者)，次要结果是全因死亡(570名患者)。进行净重分类改进(NRI)和综合判别(IDI)分析。轻、中、重度异常心肌梗死危险比分别为2.3%(95%CI1.4~3.8，P=0.001)、4.2%(95%CI2.3~7.5P<；0.001)和4.9%(95%CI2.5~9.6，P<；0.0001)。在临床信息(年龄、女性、体重指数、高血压、糖尿病、血脂异常、吸烟、心绞痛、倍他乐克的使用、既往血管重建术和静息心率)中加入心肌缺血和疤痕的百分比改善了模型的性能[C-统计0.805(95%CI，0.772-0.838)至0.839(95%CI，0.809-0.869)]和心脏性死亡的风险重新分类[NRI 0.116(95%CI 0.021-0.210)]，但对全因死亡的风险评估改善较小。在已知或疑似冠心病的患者中，与传统的冠状动脉危险因素相比，PET MPI上缺血和瘢痕的范围和严重程度提供了强大的、增加的心脏性死亡和全因死亡的风险估计。
The primary objective of this multicenter registry was to study the prognostic value of PET MPI and the improved classification of risk in a large cohort of patients with suspected or known coronary artery disease (CAD). Limited prognostic data are available for myocardial perfusion imaging (MPI) with positron emission tomography (PET). 7,061 patients from 4 centers underwent a clinically indicated rest/stress rubidium-82 PET MPI with a median follow-up of 2.2 years. The primary outcome of this study was cardiac-death (169 patients) and the secondary outcome was all-cause death (570 patients). Net reclassification improvement (NRI) and integrated discrimination (IDI) analyses were performed. Risk-adjusted hazard of cardiac-death increased with each 10% abnormal myocardium with mildly, moderately or severely abnormal stress PET [hazard ratio 2.3 (95% CI 1.4–3.8, P=0.001), 4.2 (95% CI 2.3–7.5, P<0.001), and 4.9 (95% CI 2.5–9.6, P <0.0001), respectively, normal MPI: referent]. Addition of %myocardium ischemic and scarred to clinical information (age, female sex, body mass index, history of hypertension, diabetes, dyslipidemia, smoking, angina, betablocker use, prior revascularization and rest heart rate) improved the model performance [C-statistic 0.805 (95% CI, 0.772–0.838) to 0.839 (95% CI, 0.809–0.869)] and risk reclassification for cardiac-death [NRI 0.116 (95% CI 0.021–0.210)] with smaller improvements in risk assessment for all-cause death. In patients with known or suspected CAD, the extent and severity of ischemia and scar on PET MPI provide powerful and incremental risk estimates of cardiac-death and all-cause death compared to traditional coronary risk factors.
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影响因子：
14
作者：
Dorbala, Sharmila;Hachamovitch, Rory;Di Carli, Marcelo F.
通讯作者：
Di Carli, Marcelo F.
影响因子：
2
作者：
Pencina, Michael J.;D'Agostino, Ralph B., Sr.;Steyerberg, Ewout W.
通讯作者：
Steyerberg, Ewout W.
DOI：
10.1016/s0735-1097(98)00501-4
发表时间：
1998-12-01
影响因子：
24
作者：
Berman, DS;Kang, XP;Hachamovitch, R
通讯作者：
Hachamovitch, R
影响因子：
120.7
作者：
Polonsky, Tamar S.;McClelland, Robyn L.;Jorgensen, Neal W.;Bild, Diane E.;Burke, Gregory L.;Guerci, Alan D.;Greenland, Philip
通讯作者：
Greenland, Philip
影响因子：
2.8
作者：
Marwick, TH;Shan, K;Lauer, MS
通讯作者：
Lauer, MS