腺苷负荷心肌灌注显像对近期经皮冠状动脉介入治疗患者的临床价值

Clinical application of the adenosine-stress myocardial perfusion imaging in patients with recent percutaneous coronary intervention

目的评估腺苷负荷心肌灌注显像（SMPI）在冠心病患者接受经皮冠状动脉介入治疗（PCI）后的临床价值。方法20例冠心病患者PCI前及后3d内各行1次腺苷SMPI。静息心肌灌注显像（RMPI）于PCI前SMPI的次日进行。心肌显像按17节段5分制进行评分。PCI后1年对患者进行电话随访（随访者不知晓患者的检查结果），在此期间发生心肌梗死或心因性死亡为严重心脏事件（HCE），PCI3个月后再次接受PCI或搭桥手术为非严重心脏事件（SCE）。率的比较行χ^2检验，频数比较行秩和检验。结果PCI前血管供血区域的可逆性节段，PCI后示90．9％（40／44）灌注有改善，不可逆缺损节段亦有41．3％（25／58）显示不同程度的改善。PCI后1年内出现1例HCE，5例SCE，预后与PCI前后受损节段灌注改善情况无关（χ^2=3．17，P〉0．05）。结论PCI后近期腺苷SMPI是评估PCI后心肌灌注的有效方法，其中可逆性缺损改善与否是评估PCI疗效的可靠指征；其预后价值有待进一步研究。

Objective This study aimed at evaluating the clinical usefulness of adenosine stress myocardial perfusion imaging （ MPI ） in patients after recent percutaneous coronary intervention （ PCI ）. Methods Twenty patients with coronary artery disease （CAD） underwent adenosine ^99Tc^m-methoxyisobutylisonitrile （MIBI） stress MPI within 3 d before and within 3 d after PCI. Rest MPI was performed on the next day after stress MPI before PCI. Semi-quantitative analysis was performed according to the standardized 17 myocardial segments for tomographic imaging and 5-point scoring system. Patient follow-up was performed with phone call about 1 year later by nuclear medicine physicians who were blind to results of the studies. Cardiac death and non-fatal myocardial infarction were considered hard cardiac events （HCE） and revascularization procedures ≥ 3 months after adenosine-stress MPI as soft cardiac events （SCE）. Statistical analysis was performed with the χ^2-test and rank sum test. Results Before PCI, stress MPI showed 44 reversible and 58 irreversible myocardial perfusion segments. After PCI, 40 of the 44 （90.9%） and 25 of the 58 （41.3%） segments demonstrated improved perfusion. Twenty patients within a mean follow-up period of （368.5 ±31.5 ） d had 1 HCE and 5 SCE. Statistics showed that there was no relationship between the improvement of myocardial perfusion and patient prognosis （χ^2= 3.17, P 〉 0.05 ）. Conclusions Stress MPI after recent PCI is a reliable method to evaluate the effects of PCI. Its prognostic value, however, needs further assessment.