心肌灌注显像对经皮冠状动脉腔内成形术后的远期预后价值  

Prognostic value of ^(99m)Tc-MIBI stress-rest myocardial SPECT imaging in patients after coronary angioplasty

作　　者：张晓丽[1] 刘秀杰[1] 高润霖[1] 史蓉芳[1] 何作祥[1] 陈纪林[1] 杨跃进[1] 杨敏福[1] 魏宏英[1] 

机构地区：[1]中国医学科学院中国协和医科大学阜外心血管病医院,北京100037

出　　处：《中华心血管病杂志》2003年第4期278-281,共4页Chinese Journal of Cardiology

摘　　要：目的　评估99mTc MIBI运动 静息心肌灌注显像对经皮冠状动脉腔内成形 (PTCA)术后患者的远期预后价值。方法　对 181例接受PTCA术或PTCA +支架术后行99mTc MIBI运动 静息心肌灌注显像的患者 ,随访 ( 36± 30 )个月。结果　根据心肌显像结果将患者分为三组 :心肌显像正常组 (n =10 1) ;心肌梗死组 (n =39) ;心肌缺血组 (n =41)。随访期间 ,如发生急性心肌梗死和死亡为恶性心脏事件 ,再次血运重建术和不稳定性心绞痛为良性心脏事件。共 37例 ( 2 0 4 % )患者发生心脏事件 ,其中心肌缺血组心脏事件发生率为 70 7% ( 2 9 4 1) ,明显高于心肌梗死组的 12 8% ( 5 39) ( χ2 =2 7 4 3 ,P <0 0 0 1)和心肌显像正常组的 3 1% ( 3 10 1) ( χ2 =72 87,P <0 0 0 1)。心肌缺血组的恶性心脏事件发生率为 7 3% ,高于正常组的 0 % ( χ2 =4 4 3 ,P <0 0 5 )。在心肌显像后 1年、3年、5年和 10年的无心脏事件率在心肌缺血组分别为 5 0 5 % ,34 4 % ,17 2 %和 17 2 % ;在正常组分别为 98 0 % ,96 4 % ,96 4 %和 96 4 % ( χ2 =96 32 ,P <0 0 0 1)。Cox多元线性回归分析显示运动显像的总积分(SSS)是预测PTCA术后发生恶性心脏事件的惟一独立危险因子 (RR 1 12 ,95 %CI:1 0 3～ 1 2 0 ,P =0 0 0 3)。运动Objective To evaluate the prognostic value of 99m Tc-MIBI stress-rest SPECT imaging in patients after percutaneous transluminal coronary angioplasty (PTCA). Methods One-hundred eighty one patients (mean age 54±9 years old) were followed-up for 36±30 months, who underwent stress and rest 99mTc-MIBI myocardial SPECT imaging 3-12 months (median 5) after PTCA. Results During the period of follow-up (36±30) months, 37 patients (20.4%) suffered from cardiac events, including 4 hard events (acute myocardial infarction) and 33 soft events (3 unstable angina pectoris, 9 bypass surgery,11 PTCA and 10 PTCA+stent). The cardiac event rate in patients with reversible perfusion defects (group 1, n=41) was 70.7%, which was significantly higher than that in patients with irreversible perfusion defects (group 2, n=39) (12.8%,χ2=27.4, P<0.001), and that in patients with normal perfusion imaging (group 3, n=101) (3.1%,χ2=72.87, P<0.001). Multivariate analysis showed that summed stress score (SSS) was the only independent predictor for hard cardiac events (RR 1.12, 95% CI:1.03-1.20, P=0.003). Summed difference score (SDS) between summed stress and rest scores was the best independent predictor for cardiac events (RR 1.09, 95% CI:1.04-1.15,P<0.001). The estimated event free survival rates of group 1 were 50.5%, 34.4%, 17.2% and 17.2% during 1, 3, 5 and 10 y of follow-up, respectively. However, the estimated event-free survival rates of group 3 were 98.0%, 96.4%, 96.4% 和96.4% during the same periods(χ2=96.32, P<0.001). Conclusion 99mTc-MIBI stress-rest SPECT imaging has important prognostic value in patients after PTCA.

关 键 词：心肌灌注显像 经皮冠状动脉腔内成形术 术后 预后 心肌梗死 

分 类 号：R541.4[医药卫生—心血管疾病]