INDEPENDENT AND INCREMENTAL PROGNOSTIC VALUE OF EXERCISE THALLIUM SINGLE-PHOTON EMISSION COMPUTED TOMOGRAPHIC IMAGING IN WOMEN

Background. This study examined the independent and incremental progno stic value of exercise thallium single-photon emission computed tomogr aphic imaging in 212 women who also underwent coronary angiography. Me thods and Results. The left ventricular ejection fraction was normal ( 65% +/- 15%). During a mean follow-up of 40 months, 27 women had event s (cardiac death or nonfatal myocardial infarction). Univariate Cox su rvival analysis showed several variables to be different between patie nts with events and those without events: age, exercise heart rate, th e extent of coronary artery disease, reversible thallium defects, numb er of segments with reversible abnormality, and size of perfusion abno rmality. Multivariate survival analysis showed that a large perfusion abnormality and age were the independent predictors of events. Actuari al life-table analysis showed that women with a large thallium abnorma lity (greater than or equal to 15% of the myocardium) had significantl y worse event-free survival rates than had women with no or small abno rmalities (Mantel-Cox statistic = 16; p = 0.0001). Conclusions. Thus e xercise thallium-201 single-photon emission computed tomographic imagi ng provides independent and incremental prognostic information to clin ical, exercise, and coronary angiographic results in women. The presen ce of a larger thallium abnormality identifies women at high risk of c ardiac events.