SPECT存活心肌评分对冠状动脉旁路移植手术远期心脏不良事件的预测作用

Prognosis for spect test of myocardial viability of the long-term adverse cardiovascular events following the coronary artery bypass graft

目的探讨核素存活心肌指标对冠状动脉旁路移植术（CABG）术后远期心脏不良事件的预测作用。方法1999年至2005年行CABG且术前进行了同位素SPECT存活心肌试验的709例冠心病病人纳入研究，术后定期随访。以左心室17节段对术前心肌存活情况进行半定量评分，结合其他潜在危险因素，COX回归分析探寻心肌存活情况与远期心源性死亡、心源性再次人院以及复合终点事件的关系，并进一步寻找心肌存活指标区分远期心脏不良事件的相应界值。结果平均随访（3．43±2．42）年。COX多元分析表明：左心室存活总分是远期心源性死亡、心源性再入院、复合终点事件的独立影响因子；左心室心肌存活总分区分远期心源性死亡、心源性再入院、复合终点事件的界值分别是15分、9分、13分。结论双核素SPECT存活心肌实验的心室17节段心肌存活评分的和，即存活总分，与远期事件均独立相关。存活总评分区分远期心源性死亡、再入院和复合终点事件的界值上、下两组中远期发生心脏事件的概率差异有统计学意义。

Objective To explore the relationship between the index of SPECT myocardial viability test of the left ventricle and long-term cardiovascular adverse events following the coronary artery bypass graft. Methods Clinical data were selected from the coronary-heart-disease patients with CABG and the isotopic SPECT test of myocardial viability prior to the operation in the Fuwai Cardiovascular Hospital, the Chinese Academy of Medical Science ＂from January 1, 1999 to December 31,2005. Total 709 patients were included in this study. Regular follow-up in patients was performed following operation. Investigate the nuclear medicine documents of the patients above; make the semi-quantitative scores of myocardial viability prior to operation by the 17-segment method of ventricle. Through the COX multi-factor analysis of the statistical methods to explore the relationship between the index of the myocardial viability and the long-term cardiac adverse events selected in advance. Results The mean duration of follow-up was （3.43 ± 2.42 ） years. The COX multi-analysis revealed that the total score of left ventricular myocardial viability is the independent impact factors for long term cardiac death, long term re-hospitalization rate and long term composite end points events. The cut off values of total score of left ventricular myocardial viability for long term cardiac death, long term reospitalization rate and long term composite end points events is 15, 9, 13 respectively. Conclusion The total score of left ventricular myocardial viability of SPECT is independently associated with long-term events, and the cut values of myocardial viability total score for long-term cardiac death, re-hospitalization and composite MACE events are 15, 9, and 13 respectively. For the groups with total scores above and below the cut off values, there is significant difference of long term cardiac events risk between groups.