Impact of left ventricular function and the extent of ischemia and scar by stress myocardial perfusion imaging on prognosis and therapeutic risk reduction in diabetic patients with coronary artery disease: Results from the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial
Impact of left ventricular function and the extent of ischemia and scar by stress myocardial perfusion imaging on prognosis and therapeutic risk reduction in diabetic patients with coronary artery disease: Results from the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial
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DOI：
10.1007/s12350-012-9548-3
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发表时间：
2012-08-01
影响因子：
2.4
通讯作者：
Iskandrian, Ami E.
中科院分区：
文献类型：
--
作者：
Shaw, Leslee J.;Cerqueira, Manuel D.;Iskandrian, Ami E.
旁路血管成形术血运重建研究2糖尿病试验证明了血运重建（REV）和强化药物（MED）治疗的长期临床有效性相似。干预后缺血负荷的比较尚未探讨，但与治疗决策相关。本研究通过随机化治疗对1,505例患者进行了1年的负荷心肌灌注断层显像（MPS）检查。由核芯实验室使用总心肌、缺血心肌和瘢痕心肌的定量百分比（%）分析MPS图像（对治疗设盲）。考克斯比例风险模型用于估计MPS变量和试验终点之间的关系。在1年时，几乎所有REV患者都接受了指定的手术;而随机分配到MED组的患者中有16%接受了冠状动脉REV。随机分配到REV组的患者比MED组患者表现出更少的负荷灌注异常（P < .001）。CABG组心肌缺血和瘢痕形成的发生率高于PCI组，占心肌的千分之五。随机分配到MED组的患者有更广泛的缺血，REV后心肌灌注异常的中位百分比较低（3% vs 9%，P = 0.01）。在1年时，59%的REV患者没有诱导性缺血，而MED患者为49%（P <0.001）。在CABG分层中，随机分配至MED组的患者缺血性（P = 0.032）和瘢痕性（P = 0.017）灌注异常发生率最高。在1年时，更广泛和严重的应激心肌灌注异常与更高的5年死亡率和心源性死亡或心肌梗死（MI）率的联合终点相关（11.3%，8.1%，6.8%，10%，5%-9.9%和1-4.9%，应激心肌异常，P <0.001）。在校正模型中，选定的MPS变量与心源性死亡或MI的风险增加显著相关（风险比= 1.11/5%，应激时异常心肌增加，P = 0.004）。治疗干预后1年的心肌灌注扫描提供了关于稳定型CAD合并糖尿病患者预后的重要信息。
The Bypass Angioplasty Revascularization Investigation 2 Diabetes trial demonstrated similar long-term clinical effectiveness of revascularization (REV) and intensive medical (MED) therapy. Comparisons of post-intervention ischemic burden have not been explored but are relevant to treatment decisions. This study examined differences in 1-year stress myocardial perfusion SPECT (MPS) abnormalities by randomized treatment.MPS was performed in 1,505 patients at 1-year following randomization. MPS images were analyzed (masked to treatment) by a Nuclear Core Laboratory using a quantitative percent (%) of total, ischemic, and scarred myocardium. Cox proportional hazards models were used to estimate the relationship between MPS variables and trial endpoints.At 1-year, nearly all REV patients underwent the assigned procedure; while 16% of those randomized to MED received coronary REV. Patients randomized to REV exhibited fewer stress perfusion abnormalities than MED patients (P < .001). CABG patients had more frequent ischemic and scarred myocardium encumbering a parts per thousand yen5% of the myocardium when compared to those receiving PCI. Patients randomized to MED had more extensive ischemia and the median % of the myocardium with perfusion abnormalities was lower following REV (3% vs 9%, P = .01). A total of 59% of REV patients had no inducible ischemia at 1-year compared to 49% of MED patients (P < .001). Within the CABG stratum, those randomized to MED had the greatest rate of ischemic (P = .032) and scarred (P = .017) perfusion abnormalities. At 1-year, more extensive and severe stress myocardial perfusion abnormalities were associated with higher 5-year rates of death and a combined endpoint of cardiac death or myocardial infarction (MI) rates (11.3%, 8.1%, 6.8%, for a parts per thousand yen10%, 5%-9.9%, and 1-4.9% abnormal myocardium at stress, respectively, P < .001). In adjusted models, selected MPS variables were significantly associated with an increased hazard of cardiac death or MI (hazard ratio = 1.11 per 5% increase in abnormal myocardium at stress, P = .004).Patient management strategies that focus on ischemia resolution can be useful to guide the efficacy of near-term therapeutic approaches. A 1-year post-therapeutic intervention myocardial perfusion scan provides important information regarding prognosis in stable CAD patients with diabetes.