Gender differences in the relation between ST-T-wave abnormalities at baseline electrocardiogram and stress myocardial perfusion abnormalities in patients with suspected coronary artery disease

The presence of ST-T-wave abnormalities in the resting electrocardiogram wa s reported as a predictor of coronary artery disease (CAD) and increased mo rbidity and mortality. However, the independent value of ST-T abnormalities for predicting the presence and severity of perfusion abnormalities during stress testing has not been studied in a homogenous patient group without known CAD. We evaluated the relation between resting ST-T abnormalities and myocardial perfusion abnormalities in 246 patients (age 59 +/- 13 years, 1 14 men and 132 women) without known CAD or previous myocardial infarction r eferred for evaluation of possible myocardial ischemia by dobutamine (up to 40 mu g/kg/min) stress sestamibi or tetrofosmin single-photon emission com puted tomographic imaging. Resting ST-T abnormalities were present in 123 p atients, whereas 123 patients with normal resting electrocardiograms served as a matched control group. Abnormal myocardial perfusion (fixed or revers ible perfusion defects) was detected in 72% of men with and in 35% of men w ithout resting ST-T abnormalities (p <0.0001), whereas the prevalence of my ocardial perfusion abnormalities was not different in women with and withou t resting ST-T abnormalities (27% vs 23%, p = NS). In the entire population , independent predictors of an abnormal perfusion by multivariate analysis of clinical characteristics and risk factors were male gender (p <0.001, ch i-square 10.5) and resting ST-T abnormalities (p <0.05, chi-sqaure 3). Sepa rate analysis of patients based on gender revealed resting ST-T abnormaliti es as independent predictors of abnormal perfusion in men (p <0.05, chi-squ are 4) but not in women. Stress perfusion defect score was higher in men wi th than without ST-T abnormalities (887 +/- 545 vs 207 +/- 180, p <0.001). It is concluded that resting ST-I wave abnormalities are associated with a higher prevalence and severity of resting and dobutamine-induced myocardial perfusion abnormalities in men but not in women. Resting ST-T wave abnorma lities are powerful predictors of compromised myocardial perfusion independ ent of other clinical risk factors of CAD in men. (C) 1999 by Excerpta Medi ca, Inc.