^(99m)Tc-MIBI运动-静息心肌灌注显像对经皮冠状动脉腔内成形术术后患者的预后估价

^(99m)Tc-MIBI myocardial SPECT imaging for evaluation of outcome in patients after coronary angioplasty

目的 本研究旨在评估运动 静息心肌灌注显像对冠状动脉腔内成形术 (PTCA)后患者预后的预测价值。方法 对 16 0例PTCA术后行99mTc 甲氧异丁基异腈 (MIBI)运动 静息心肌灌注显像的患者 ,随访 (36± 2 8)个月。结果 随访期间 ,34例 (2 1.3% )患者发生心脏事件 ,其中心肌显像提示的心肌缺血组 (n =4 3)心脏事件发生率为 6 2 .8% ,明显高于心肌梗死组 (n =32 ,12 .5 % ,χ2 =19.3,P <0 .0 0 0 1) ,而且也明显高于心肌显像正常组(n =85 ,3.5 % ,χ2 =5 7.4 4 ,P <0 .0 0 0 1)。心肌缺血组的无心脏事件生存率在 1年 ,3年 ,5年和 10年分别为 5 6 % ,32 % ,2 6 %和 2 6 % ,而正常组在相同时间内的无心脏事件生存率为 99% ,97% ,94 %和 94 %。多元线性分析显示 ,可逆性心肌灌注缺损节段是预测PTCA术后发生心脏事件的最重要的独立危险因子 (RR =5 .13,P <0 .0 0 0 1)。结论 99mTc MIBI运动

Objective To evaluate the outcome of patients with coronary artery disease(CAD) after percutaneous transluminal coronary angioplasty (PTCA) with 99m Tc MIBI SPECT imaging. Methods One hundred and sixty patients 〔mean age 54±9)years old〕 underwent stress and rest 99m Tc MIBI myocardial SPECT imaging after PTCA were followed up for (36±28) months. Results During the period of follow up, 34 patients ( 21.3% ) suffered from cardiac events, including 4 with acute myocardial infarction, 3 with unstable angina pectoris, 8 with bypass surgery and 19 with PTCA. The cardiac event rate in patients with reversible perfusion defects (group 1, n=43) was 62.8% , which was significantly higher than that in patients with irreversible perfusion defects (group 2, n=32, 12.5% ,χ 2=19.3, P< 0.0001 ), and higher than that in patients with normal perfusion imaging (group 3, n=85, 3.5% , χ 2= 57.44 , P< 0.0001 ). Univariate and multivariate analyses showed that reversible perfusion defect was the best independent predictor for cardiac events (P<0.0001). The estimated event free survival rates of group 1 were 56%, 32%, 26% and 26% at 1, 3, 5 and 10 years of follow up, respectively. However, the estimated event free survival rates of group 3 were 99%, 97%, 94%and 94% during the same periods. Conclusions The results show that stress rest 99m Tc MIBI SPECT imaging can be used for stratifying patients into low, intermediate and high risk of future cardiac events after PTCA.