核素心肌显像对冠心病患者不同心脏事件预测的分析

摘要

Objective To explore the predictive value of myocardial perfusion imaging for cardiac events, including nonfatal myocardial infarction( MI ), unstable angina ( UAP ) and cardiac death in patients with coronary artery disease. Methods Of the 674 cases, 580 cases ( 86. 05% ) were successfully followed up. Visual scoring were evaluated with 20 segments and a scale of 1 - 4 . The global summed stress score ( SSS ), summed rest score ( SRS ) and the summed difference score ( SDS = SSS - SRS ) were calculated. Results Among 580 patients, there were 89 cases occurred cardiac events( 32 of nonfatal myocardial infarction, 32 of unstable angina and 25 of cardiac death ). Cox regression analysis showed SSS was the best predictors of cardiac death. SDS was the best predictors of nonfatal acute myocardial infarction and unstable angina. Conclusion Myocardial perfusion SPECT can assess the risk of cardiac events in patients with coronary artery diseases and can assist in determining the appropriate treatment strategy for individual patient.%目的 研究核素心肌显像对冠心病(CAD)患者不同心脏事件(非致死性心肌梗死、不稳定型心绞痛和心源性死亡)进行预测的意义.方法 对674例行核素心肌灌注显像的已知或可疑CAD的患者进行随访,观察其心脏事件的发生情况.将成功随访580例患者心肌灌注图像应用20节段的半定量评分法进行评分,心肌灌注图像应用20节段的半定量评分法进行评分(1~4分),计算总负荷评分(SSS)、总静息评分(SRS)和总差值分(SDS=SRS-SSS).结果 580例受访者中,发生心脏事件89例(占随访人群的15.34%),其中发生非致死性心肌梗死或梗死面积扩大的32例(35.96%),发生不稳定型心绞痛32例(35.96%),发生心源性死亡25例(28.09%).Cox比例风险回归分析提示SSS是心源性死亡的最强预测因素,SDS是非致死性心肌梗死与不稳定心绞痛的最强预测因素.结论 核素心肌显像对冠心病患者不同心脏事件的发生具有一定的预测价值,可为临床预后和疗效推断提供一定的依据.