Temporal Trends in the Frequency of Inducible Myocardial Ischemia During Cardiac Stress Testing 1991 to 2009
Temporal Trends in the Frequency of Inducible Myocardial Ischemia During Cardiac Stress Testing 1991 to 2009
复制标题
DOI：
10.1016/j.jacc.2012.11.056
复制
发表时间：
2013-03-12
影响因子：
24
通讯作者：
Berman, Daniel S.
中科院分区：
文献类型：
--
作者：
Rozanski, Alan;Gransar, Heidi;Berman, Daniel S.
目的 本研究旨在评估应激休息单光子发射计算机断层扫描 (SPECT) 心肌灌注成像 (MPI) 期间诱导性心肌缺血的频率是否随时间发生变化。 背景 近几十年来，心源性死亡和其他临床心脏事件的患病率有所下降，但迄今为止还没有研究检查心脏应激测试期间诱导性心肌缺血的频率是否存在时间变化。 方法 我们评估了 39,515 名接受应激休息 MPI 的诊断患者1991 年至 2009 年间。对患者的人口统计学、临床症状、危险因素以及异常和缺血性 SPECT-MPI 频率的变化进行评估。结果 SPECT 研究异常的发生率明显逐渐下降，从 1991 年的 40.9% 下降到 2009 年的 8.7%（p < 0.001）。同样，缺血性 SPECT-MPI 的患病率从 29.6% 下降至 5.0% (p < 0.001)，严重缺血的患病率也是如此。所有年龄和症状亚组的 SPECT-MPI 异常均出现下降，近期运动但无典型心绞痛患者的 SPECT-MPI 异常下降至仅 2.9%。我们还注意到，在所有年龄和体重组中，逐渐出现药物应激而非运动应激的趋势，并且药物应激比运动更有可能与 SPECT-MPI 异常相关（比值比：1.43，95% 置信区间：1.3 至 1.5；p < 0.001）。 结论 在过去 20 年中，异常应激 SPECT-MPI 研究的频率和严重程度逐渐下降。值得注意的是，在没有典型心绞痛的运动患者中，异常 SPECT-MPI 的频率现在非常低。这些发现表明，需要制定更具成本效益的策略，对目前在心脏成像过程中表现出诱导性心肌缺血风险较低的患者进行初步检查。 (J Am Coll Cardiol 2013;61:1054-65) (C) 2013 年，美国心脏病学会基金会
Objectives This study sought to assess whether the frequency of inducible myocardial ischemia during stress-rest single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) has changed over time.Background The prevalence of cardiac death and other clinical cardiac events have declined in recent decades, but heretofore no study has examined if there has been a temporal change in the frequency of inducible myocardial ischemia during cardiac stress testing.Methods We assessed 39,515 diagnostic patients undergoing stress-rest MPI between 1991 and 2009. Patients were assessed for change in demographics, clinical symptoms, risk factors, and frequency of abnormal and ischemic SPECT-MPI.Results There was a marked progressive decline in the prevalence of abnormal SPECT studies, from 40.9% in 1991 to 8.7% in 2009 (p < 0.001). Similarly, the prevalence of ischemic SPECT-MPI declined, from 29.6% to 5.0% (p < 0.001), as did the prevalence of severe ischemia. The decline of SPECT-MPI abnormality occurred among all age and symptom subgroups, falling to only 2.9% among recent exercising patients without typical angina. We also noted a progressive trend toward performing more pharmacological rather than exercise stress in all age and weight groups, and pharmacological stress was more likely than exercise to be associated with SPECT-MPI abnormality (odds ratio: 1.43, 95% confidence interval: 1.3 to 1.5; p < 0.001).Conclusions Over the past 2 decades, the frequency and severity of abnormal stress SPECT-MPI studies has progressively decreased. Notably, the frequency of abnormal SPECT-MPI is now very low among exercising patients without typical angina. These findings suggest the need for developing more cost-effective strategies for the initial work-up of patients who are presently at low risk for manifesting inducible myocardial ischemia during cardiac imaging procedures. (J Am Coll Cardiol 2013;61:1054-65) (C) 2013 by the American College of Cardiology Foundation