Prognostic utility of the exercise thallium-201 test in ambulatory patients with chest pain: comparison with cardiac catheterization.
Prognostic utility of the exercise thallium-201 test in ambulatory patients with chest pain: comparison with cardiac catheterization.
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运动铊 201 试验对胸痛门诊患者的预后效用：与心导管插入术的比较。
DOI：
10.1161/01.cir.77.4.745
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发表时间：
1988
期刊：
影响因子：
37.8
通讯作者：
Beller,GA
中科院分区：
文献类型：
--
作者：
Kaul,S;Lilly,DR;Gascho,JA;Watson,DD;Gibson,RS;Oliner,CA;Ryan,JM;Beller,GA
本研究的目的是确定运动铊-201负荷试验在胸痛患者中的预后效用，这些患者也被称为心导管插入术。因此，从1978年到1981年，除了一名患者外，所有383名接受运动铊-201负荷试验和心导管插入术的患者都获得了4到8年（平均值± 1 SD，4.6 ± 2.6年）的随访数据。83例患者在测试后3个月内进行了血运重建手术，并从分析中排除。在其余299例患者中，210例无事件，89例有事件（41例死亡，9例非致死性心肌梗死，39例血运重建术大于或等于测试后3个月）。当通过考克斯回归分析对所有临床、运动、铊-201和导管插入术变量进行分析时，病变血管数（当定义为大于或等于50%管腔直径狭窄时）是未来心脏事件的单一最重要预测因素（卡方= 38.1），其次是延迟铊-201图像上显示再分布的节段数（卡方= 16.3），除了非致死性心肌梗死的情况下，再分布是未来事件的最重要的预测因子。当冠状动脉疾病定义为70%或更大的管腔直径狭窄时，病变血管的数量显著（p <0.01）失去了预测事件的能力（卡方= 14.5）。其他独立预测未来事件的变量包括从休息到运动的心率变化（卡方2 = 13.0）、运动时ST段压低（卡方2 = 13.0）、运动时室性心律失常的发生（卡方2 = 5.9）和β受体阻滞剂治疗（卡方2 = 4.3）。排除心肌血运重建手术作为事件并未显著改变结果。虽然患病血管的数量是未来事件的最重要的决定因素，但运动铊-201负荷试验作为一个整体考虑时，（包括延迟铊-201图像上显示再分布的节段数量，从休息到运动的心率变化，心电图上的ST段压低，运动时室性早搏）同样有效（χ 2 = 41.6）。导管插入术和运动铊-201数据的组合上级单独使用（卡方= 57.5），以确定未来的事件。单独运动负荷试验（无铊-201数据）在预测未来事件方面不如运动铊-201负荷试验或心导管检查（卡方= 30.6）。（400字处截断摘要）
The goal of this study was to determine the prognostic utility of the exercise thallium-201 stress test in ambulatory patients with chest pain who were also referred for cardiac catheterization. Accordingly, 4 to 8 year (mean +/- 1SD, 4.6 +/- 2.6 years) follow-up data were obtained for all but one of 383 patients who underwent both exercise thallium-201 stress testing and cardiac catheterization from 1978 to 1981. Eighty-three patients had a revascularization procedure performed within 3 months of testing and were excluded from analysis. Of the remaining 299 patients, 210 had no events and 89 had events (41 deaths, nine nonfatal myocardial infarctions, and 39 revascularization procedures greater than or equal to 3 months after testing). When all clinical, exercise, thallium-201, and catheterization variables were analyzed by Cox regression analysis, the number of diseased vessels (when defined as greater than or equal to 50% luminal diameter narrowing) was the single most important predictor of future cardiac events (chi 2 = 38.1) followed by the number of segments demonstrating redistribution on delayed thallium-201 images (chi 2 = 16.3), except in the case of nonfatal myocardial infarction, for which redistribution was the most important predictor of future events. When coronary artery disease was defined as 70% or greater luminal diameter narrowing, the number of diseased vessels significantly (p less than .01) lost its power to predict events (chi 2 = 14.5). Other variables found to independently predict future events included change in heart rate from rest to exercise (chi 2 = 13.0), ST segment depression on exercise (chi 2 = 13.0), occurrence of ventricular arrhythmias on exercise (chi 2 = 5.9), and beta-blocker therapy (chi 2 = 4.3). The exclusion of myocardial revascularization procedures as an event did not change the results significantly. Although the number of diseased vessels was the single most important determinant of future events, the exercise thallium-201 stress test when considered as a whole (which included the number of segments demonstrating redistribution on delayed thallium-201 images, change in heart rate from rest to exercise, ST segment depression on the electrocardiogram, and ventricular premature beats on exercise) was equally powerful (chi 2 = 41.6). Combination of both catheterization and exercise thallium-201 data was superior to either alone (chi 2 = 57.5) for determining future events. Exercise stress test alone (without thallium-201 data) was inferior to the exercise thallium-201 stress test or cardiac catheterization for predicting future events (chi 2 = 30.6).(ABSTRACT TRUNCATED AT 400 WORDS)