INCREMENTAL PROGNOSTIC VALUE OF ADENOSINE MYOCARDIAL PERFUSION SINGLE-PHOTON EMISSION COMPUTED-TOMOGRAPHY IN WOMEN WITH SUSPECTED CORONARY-ARTERY DISEASE

Adenosine myocardial perfusion single-photon emission computed tomogra phy (SPECT) is now increasingly used for risk stratification of patien ts with known or suspected coronary artery disease. However, the incre mental prognostic value of this test over clinical and historical info rmation in a large series of women has not been examined. Thus, we stu died 923 consecutive women who underwent adenosine technetium (Tc)-99m sestamibi myocardial perfusion SPECT and were followed-up for a mean period of 26 +/- 8 months. During the follow-up period, 77 hard events (46 cardiac deaths and 31 nonfatal myocardial infarctions) occurred. The results of the perfusion scan significantly risk stratified the po pulation; patients with normal scans had a low rate of nonfatal myocar dial infarction and cardiac death (<1%/year of follow up). Patients wi th mildly abnormal scans had low cardiac death rates (0.9%/year of fol low up); these rates increased as a function of scan abnormality (4.1% and 7.5% mortality per year of follow vp in moderate and severely abn ormal scans). Cox proportional hazards analysis demonstrated that afte r adjusting for prior myocardial infarction and diabetes mellitus (the most predictive individual clinical variables [global chi-square = 22 .5, p <0.001]), as well as heart rate at rest (the most predictive phy siologic variable [chi-square = 3.8; p = 0.05]), the most predictive n uclear variable (summed stress score [chi-square = 48.5; p <0.0001]) a dded significant incremental prognostic information (global chi-square increased from 22.5 to 56.2 [p <0.0001]). In conclusion, adenosine my ocardial perfusion SPECT added significant incremental prognostic info rmation to clinical and physiologic variables in women. Normal scans w ere associated with an excellent prognosis. In contrast, patients with moderately to severely abnormal scans were at a higher risk for futur e cardiac events. (C) 1998 by Excerpta Medica, Inc.