Exercise myocardial perfusion SPECT in patients without known coronary artery disease: Incremental prognostic value and use in risk stratification
Exercise myocardial perfusion SPECT in patients without known coronary artery disease: Incremental prognostic value and use in risk stratification
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DOI：
10.1161/01.cir.93.5.905
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发表时间：
1996-03-01
期刊：
影响因子：
37.8
通讯作者：
Diamond, GA
中科院分区：
文献类型：
--
作者：
Hachamovitch, R;Berman, DS;Diamond, GA
背景：在一组既往无心肌梗死、导尿术或血管重建的患者中，我们评估了心肌灌注单光子发射计算机断层扫描(SPECT)的增量预后价值、在风险分层中的作用以及对患者管理的影响。方法与结果我们连续检查了2200名患者，这些患者在接受SPECT检查时没有接受过导管术、冠状动脉旁路手术或经皮冠状动脉腔内成形术，也没有已知的心肌梗死病史。对于硬事件(心脏性死亡和心肌梗死)以及在核试验后60天内转诊为心导管或血运重建的患者，进行了平均566+/-142天(97%完成)的随访。使用逐步Cox比例风险模型和受试者-操作特征曲线分析对临床、运动和核模型进行运动前耐量试验(ETT)、运动后和核信息的检验，结果显示，在纳入最具预测性的临床和运动变量后，核试验增加了增量预后价值(临床变量和运动变量的全局X_1(2)=12；临床+运动变量=31；核变量为169；CHI(2)的增益，P
Background We evaluated the incremental prognostic value, the role in risk stratification, and the impact on patient management of myocardial perfusion single-photon emission computed tomography (SPECT) in a population of patients without prior myocardial infarction, catheterization, or revascularization.Methods and Results We examined 2200 consecutive patients who at the time of their dual-isotope SPECT had not undergone catheterization, coronary artery bypass surgery, or percutaneous transluminal coronary angioplasty and had no known history of previous myocardial infarction. Follow-up was performed at a mean of 566+/-142 days (97% complete) for hard events (cardiac death and myocardial infarction) and for referral to cardiac catheterization or revascularization within 60 days after nuclear testing. Examination of clinical, exercise, and nuclear models by use of pre-exercise tolerance test (ETT), post-ETT, and nuclear information using a stepwise Cox proportional hazards model and receiver-operating characteristic curve analysis revealed that nuclear testing added incremental prognostic value after inclusion of the most predictive clinical and exercise variables (global chi(2)=12 for clinical variables; 31 for clinical + exercise variables; 169 for nuclear variables; gain in chi(2), P