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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 静
Objective To evaluate the long-term prognosis of 99mTc MIBI resting myocardial perfusion imaging in patients undergoing percutaneous transluminal coronary angioplasty (PTCA). Methods A total of 181 patients undergoing 99mTc MIBI resting myocardial perfusion imaging after PTCA or PTCA + stent were followed up for 36 ± 30 months. Results According to myocardial imaging results, the patients were divided into three groups: normal myocardial imaging group (n = 10 1), myocardial infarction group (n = 39), myocardial ischemia group (n = 41). During follow-up, revascularization and unstable angina are benign cardiac events in the event of acute myocardial infarction and death as a malignant cardiac event. A total of 37 patients (20.4%) had cardiac events. The incidence of cardiac events in myocardial ischemia group was 70 7% (2 9 4 1), significantly higher than that in myocardial infarction group 12 8% (5 39) (χ 2 = 2 7 4 3, P 0 01), and 3 1% (3 10 1) of the myocardial imaging group (χ 2 = 72 87, P 0 01 0). The incidence of malignant cardiac events in myocardial ischemia group was 73%, which was higher than that in normal group (χ2 = 443, P <0 05). Cardiac imaging at 1 year, 3 years, 5 years and 10 years of no cardiac events in the myocardial ischemia group were 55%, 34 4%, 17 2% and 17 2%; in the normal group were 98 0%, 96 4%, 96 4% and 96 4% (χ2 = 96 32, P <0 0 0 1). Cox multivariate linear regression analysis showed that the total score of exercise imaging (SSS) was the only independent risk factor for predicting malignant cardiac events after PTCA (RR 1 12, 95% CI: 103 ~ 120, P = 0 0 0 3). Static movement