Impact of Appropriate Use on the Prognostic Value of Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging
Impact of Appropriate Use on the Prognostic Value of Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging
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DOI：
10.1161/circulationaha.113.002744
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发表时间：
2013-10-08
期刊：
影响因子：
37.8
通讯作者：
Hendel, Robert C.
中科院分区：
文献类型：
--
作者：
Doukky, Rami;Hayes, Kathleen;Hendel, Robert C.
背景：已制定了适当的使用标准（AUC），以帮助单光子发射计算机断层扫描（SPECT）-心肌灌注成像（MPI）的最佳使用，MPI是缺血性心脏病风险评估的主要技术。SPECT-MPI的预后价值的适当使用的影响是unknown.Methods和Results一个前瞻性队列研究的1511例连续患者接受门诊，社区为基础的SPECT-MPI进行。根据SPECT-MPI的2009 AUC，将受试者分层为适当或不确定适当性组和不适当组。患者前瞻性随访27 - 10个月，观察死亡、死亡或心肌梗死以及心源性死亡或心肌梗死等主要心脏不良事件。在整个队列中，167例（11%）扫描异常的受试者的主要不良心脏事件和冠状动脉血运重建率显著高于MPI正常的受试者。在823名受试者中，（54.5%）其MPI被归类为适当（779，51.6%）或不确定（44，2.9%），异常扫描预示死亡率成倍增加（9.2% vs 2.6%;风险比，3.1; P=0.004），死亡或心肌梗死（11.8% vs 3.3%;风险比，3.3; P=0.001），心源性死亡或心肌梗死（6.7%对1.7%;风险比，3.7; P=0.006）和血运重建（24.7%对2.7%;风险比，11.4; P
Background Appropriate use criteria (AUC) have been developed to aid in the optimal use of single-photon emission computed tomography (SPECT)-myocardial perfusion imaging (MPI), a technique that is a mainstay of risk assessment for ischemic heart disease. The impact of appropriate use on the prognostic value of SPECT-MPI is unknown.Methods and Results A prospective cohort study of 1511 consecutive patients undergoing outpatient, community-based SPECT-MPI was conducted. Subjects were stratified on the basis of the 2009 AUC for SPECT-MPI into an appropriate or uncertain appropriateness group and an inappropriate group. Patients were prospectively followed up for 2710 months for major adverse cardiac events of death, death or myocardial infarction, and cardiac death or myocardial infarction. In the entire cohort, the 167 subjects (11%) with an abnormal scan experienced significantly higher rates of major adverse cardiac events and coronary revascularization than those with normal MPI. Among the 823 subjects (54.5%) whose MPIs were classified as appropriate (779, 51.6%) or uncertain (44, 2.9%), an abnormal scan predicted a multifold increase in the rates of death (9.2% versus 2.6%; hazard ratio, 3.1; P=0.004), death or myocardial infarction (11.8% versus 3.3%; hazard ratio, 3.3; P=0.001), cardiac death or myocardial infarction (6.7% versus 1.7%; hazard ratio, 3.7; P=0.006), and revascularization (24.7% versus 2.7%; hazard ratio, 11.4; P