Feasibility of combined risk stratification with coronary CT angiography and stress myocardial SPECT in patients with chronic coronary artery disease
Feasibility of combined risk stratification with coronary CT angiography and stress myocardial SPECT in patients with chronic coronary artery disease
复制标题
DOI：
10.1007/s12149-017-1214-z
复制
发表时间：
2018-01-01
影响因子：
2.6
通讯作者：
Kumita, Shin-ichiro
中科院分区：
文献类型：
--
作者：
Kiriyama, Tomonari;Fukushima, Yoshimitsu;Kumita, Shin-ichiro
为研究冠状动脉CT血管造影（CTA）相对于心肌灌注成像（MPI）在疑似或已知冠状动脉疾病患者中的额外预后价值，对157例患者（平均年龄69 ± 9岁; 76%为男性;中位随访时间49个月;范围12-82个月）进行了负荷MPI联合SPECT和冠状动脉CTA，间隔6个月。检查负荷MPI的总负荷评分（SSS）和总差异评分（SDS）、狭窄血管数量以及冠状动脉CTA上左主干狭窄和高危斑块的存在。主要终点为心源性死亡、急性心肌梗死或需要血运重建的不稳定型心绞痛。次要终点是后一次成像试验后> 60天的血运重建。所有患者随访至少1年（平均45 ± 19个月，范围12-82个月），9例（6%）患者达到主要终点。1例（0.6%）患者发生心源性死亡，5例（3%）发生心肌梗死，3例（2%）发生需要住院治疗的不稳定型心绞痛。31例（20%）患者在60天内进行了选择性血运重建。16例（10%）患者在> 60天后需要血运重建。主要终点无事件生存率在心肌缺血（SDS >= 2）和高危斑块（HRP）患者中显著降低，次要终点无事件生存率在SSS >= 4和3VD患者中显著降低。多因素分析中，考克斯比例风险回归分析显示，HRP（HR = 8.02; P = 0.006）和心肌缺血（HR = 11.487; P = 0.025）是主要终点的显著预测因子，3VD是次要终点的显著预测因子（HR = 4.981; P = 0.008）。联合缺血和HRP导致模型卡方在预测缺血或单独HRP的主要终点方面显著增加（分别为17.4 vs.9.41; P = 0.005，17.4 vs.9.39; P = 0.005）。冠状动脉CT血管造影可能提供比MPI更多的预后信息。
To examine the additional prognostic value of coronary CT angiography (CTA) over myocardial perfusion imaging (MPI) in patients with suspected or known coronary artery disease.A series of 157 patients (mean age 69 +/- 9 years; 76% male; median follow-up 49 months; range 12-82 months) underwent stress MPI with SPECT and coronary CTA within a 6-month interval. Summed stress score (SSS) and summed difference score (SDS) of stress MPI, number of vessels with stenosis, and presence of left main trunk stenosis and high-risk plaques on coronary CTA were examined. Primary endpoints were cardiac death, acute myocardial infarction, or unstable angina requiring revascularization. Secondary endpoints were revascularization > 60 days after the latter imaging test. All patients were followed up for at least 1 year (mean 45 +/- 19 months; range 12-82 months).Nine (6%) patients reached primary endpoints. Cardiac death occurred in 1 (0.6%) patient, myocardial infarction in 5 (3%), and unstable angina requiring hospitalization in 3 (2%). Elective revascularization within 60 days was performed in 31 (20%) patients. Sixteen (10%) patients required revascularization after > 60 days. Primary endpoint event-free survival rates were significantly lower in patients with myocardial ischemia (SDS >= 2) and high-risk plaques (HRP), and secondary endpoint event-free survival rates in patients with SSS >= 4 and 3VD. In multivariate analysis, Cox proportional hazards regression analysis revealed HRP (HR = 8.02; P = 0.006) and myocardial ischemia (HR = 11.487; P = 0.025) were significant predictors of primary endpoints, and 3VD of secondary endpoints (HR = 4.981; P = 0.008). Combined ischemia and HRP resulted in the significant increase of the model Chi square in prediction of primary end points from ischemia or HRP alone (17.4 vs. 9.41; P = 0.005, 17.4 vs. 9.39; P = 0.005, respectively).Coronary CT angiography may provide additional prognostic information over MPI.