Relation of gender to physician use of test results and to the prognostic value of stress technetium 99m sestamibi myocardial single-photon emission computed tomography scintigraphy

doi:10.1016/S0002-8703(97)70109-1

American Heart Journal

Volume 134, Issue 1, July 1997, Pages 73-82

Presented in part at the Society of Nuclear Medicine Scientific Sessions, Denver, June 1996, and at the American College of Cardiology 45th Annual Scientific Sessions, Orlando, Fla., March 1996.

https://doi.org/10.1016/S0002-8703(97)70109-1 Get rights and content

Abstract

We analyzed potential gender differences in the use and prognostic value of stress technetium 99m sestamibi tomography, image results, and cardiac event rates over a period of 15 ± 8 months in 1226 men and 1151 women. Men had more abnormal tomographic images, but referral for catheterization and revascularization similarly increased in relation to the number of defects. Men and women with abnormal images had similar event rates, 19.6% and 18.2%, respectively, although men more often had myocardial infarction or cardiac death (7.6% vs 4.1%, p < 0.05), whereas women had an increased likelihood of unstable angina or congestive heart failure (11.5% vs 7.6%, p < 0.05). Normal images predicted a low yearly rate of myocardial infarction or death: 1.7% for men and 0.8% for women. Image findings, particularly defect extent, were independent predictors of events in both groups. Thus, after stress Tc-99m sestamibi single-photon emission computed tomography perfusion imaging, there was no gender bias in referral for invasive procedures, and for both men and women image findings were strongly associated with prognostic outcome. (Am Heart J 1997;134:73-82.)

Section snippets

Study design

Data were prospectively collected for 2377 consecutive patients (1226 men, 1151 women) who underwent either treadmill exercise or dipyridamole stress Tc-99m sestamibi tomographic myocardial perfusion imaging at either Memorial Hospital of Rhode Island or Roger Williams Medical Center from 1991 through 1993. All patients completed a questionnaire detailing risk factors, reasons for testing, and medications. The pretest likelihood of coronary disease was categorized as “low” (<20% likelihood),

Patient characteristics

Table I outlines the baseline clinical characteristics of the 2377 patients. Women were older than men and were referred more frequently for testing for evaluation of chest pain. Men were more likely to have had a previous history of cardiac disease, including a revascularization procedure. Women had a higher prevalence of cardiac risk factors.

Myocardial imaging results

For all patients, men had more abnormal SPECT sestamibi images than women (Table II) . This finding was found to be unrelated to differences in the age

Discussion

The purpose of this study was to assess the impact of gender on both physician use of stress sestamibi SPECT image results and on the prognostic value of the test. We found no evidence of gender bias because referrals for catheterization and revascularization procedures for men and women similarly increased as the extent of tomographic perfusion abnormalities increased. For both genders, abnormal SPECT images increased the incidence of a cardiac event compared with normal images, from 4.4% to

Acknowledgements

We thank David Waters, MD, for assistance in reviewing and providing many helpful suggestions for this manuscript.

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^☆: From the Division of Cardiology, Roger Williams Medical Center; the Nuclear Cardiology Laboratory, Division of Cardiology, Memorial Hospital of Rhode Island; the Brown University School of Medicine, the Nuclear Cardiology Laboratory, Division of Cardiology, Hartford Hospital; the University of Connecticut School of Medicine; and the School of Public Health, University of Massachusetts at Amherst.

^☆☆: Reprint requests: Mark I. Travin, MD, Division of Cardiology, Roger Williams Medical Center, 825 Chalkstone Ave., Providence, RI 02908.

^★: 0002-8703/97/$5.00 + 0 4/1/82547

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Relation of gender to physician use of test results and to the prognostic value of stress technetium 99m sestamibi myocardial single-photon emission computed tomography scintigraphy☆,☆☆,★

Abstract

Section snippets

Study design

Patient characteristics

Myocardial imaging results

Discussion

Acknowledgements

Am Heart J

Cardiol Clin

J Am Coll Cardiol

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

J Nucl Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Am J Cardiol

Am J Cardiol

Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease

N Engl J Med

Cardiovascular health and disease in women

N Engl J Med

Prognostic value of thallium-201 myocardial perfusion imaging

Circulation

Gender differences in the noninvasive evaluation and management of patients with suspected coronary artery disease

Ann Intern Med