Clinical Outcomes of Dynamic Computed Tomography Myocardial Perfusion Imaging Combined With Coronary Computed Tomography Angiography Versus Coronary Computed Tomography Angiography-Guided Strategy
Clinical Outcomes of Dynamic Computed Tomography Myocardial Perfusion Imaging Combined With Coronary Computed Tomography Angiography Versus Coronary Computed Tomography Angiography-Guided Strategy
复制标题
动态计算机断层扫描心肌灌注成像结合冠状动脉计算机断层扫描血管造影与冠状动脉计算机断层扫描血管造影引导策略的临床结果。
DOI：
10.1161/circimaging.119.009775
复制
发表时间：
2020-01-01
影响因子：
7.5
通讯作者：
Zhang, Jiayin
中科院分区：
文献类型：
--
作者：
Yu, Mengmeng;Shen, Chengxing;Zhang, Jiayin
背景：动态计算机断层扫描（CT）心肌灌注成像（MPI）为精确评估心肌缺血提供了定量的心肌血流量。然而，与冠状动脉CT血管造影（CCTA）相比，这种功能成像方式是否能减少侵入性冠状动脉造影而不发生血运重建术尚不清楚。我们的目的是确定动态CT-MPI+ ccta引导与ccta引导策略在疑似冠状动脉疾病患者中的临床结果。方法：前瞻性招募具有中等预测冠状动脉疾病概率的连续患者，并随机分为动态CT-MPI+ ccta引导或ccta引导的随访。主要终点是3个月内无血管重建的有创冠状动脉造影的发生率。次要终点是3个月、6个月和1年随访期间主要心脏不良事件的综合。结果：共纳入240例患者（平均年龄69.01±11.2岁，男性173例）。CT-MPI+CCTA组90天内的总辐射剂量和造影剂使用量均高于CCTA组（10.3 vs 7.1 mSv， P=0.031; 134.5 +/- 40.6 vs 108.1 +/- 48.2 mL， P=0.031）
BACKGROUND: Dynamic computed tomography (CT) myocardial perfusion imaging (MPI) provides quantitative myocardial blood flow for the precise assessment of myocardial ischemia. However, compared with coronary CT angiography (CCTA), whether this functional imaging modality can reduce invasive coronary angiography without revascularization remains unknown. We aimed to determine the clinical outcomes of a dynamic CT-MPI+CCTA-guided versus CCTA-guided strategy in patients with suspected coronary artery disease.METHODS: Consecutive patients with intermediate pretest probability of coronary artery disease were prospectively enrolled and randomized to dynamic CT-MPI+CCTA-guided or CCTA-guided workup. The primary end point was the rate of invasive coronary angiography without revascularization within 3 months. The secondary end point was a composite of major adverse cardiac event at the 3-month, 6-month, and 1-year follow-up.RESULTS: A total of 240 patients (mean age, 69.01 +/- 11.2 years; 173 men) were included. The total radiation dose and contrast media usage within 90 days were higher in the CT-MPI+CCTA group than in the CCTA group (10.3 versus 7.1 mSv, P=0.031; 134.5 +/- 40.6 versus 108.1 +/- 48.2 mL, P