IDENTIFICATION OF SEVERE OR EXTENSIVE CORONARY-ARTERY DISEASE IN WOMEN BY ADENOSINE TC-99M SESTAMIBI SPECT

To assess the ability of adenosine technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography (SPECT) to ident ify high-risk women with severe or extensive coronary artery disease ( CAD), we studied 130 consecutive women who underwent adenosine sestami bi myocardial perfusion SPECT and catheterization within 2 months. Sev ere (greater than or equal to 50% stenosis of left main coronary arter y, greater than or equal to 90% stenosis in the proximal left anterior descending or in greater than or equal to 2 coronary arteries) or ext ensive (greater than or equal to 70% stenosis in 3 vessels) CAD was pr esent in 54 patients, whereas 76 had no CAD or mild to moderate CAD. S emiquantitative visual SPECT analysis used 20 segments and a 5-point s coring system (0 = normal, 4 = absent uptake). Among the clinical, hem odynamic and nuclear variables analyzed, univariate predictors of seve re or extensive CAD included a higher prescan likelihood of CAD, histo ry of myocardial infarction, a higher heart rate at rest, a lower incr ease in heart rate during adenosine infusion, a higher summed stress s core, summed reversibility score, and multivessel scan abnormality. Mu ltivariate logistic analysis of the most predictive clinical (prescan likelihood of CAD), hemodynamic (increase in heart rate during adenosi ne infusion), and scan variables [summed stress score) revealed summed stress score (chi-square = 32; p <0.0001) and prescan likelihood of C AD (chi-square = 6.4; p <0.05) as the only independent predictors of s evere or extensive CAD. Based on these logistic models, we determined the probability for the presence of severe or extensive CAD in patient s with low, intermediate, and high prescan likelihood of CAD across th e range of valves of a summed stress scare. This revealed that there w ere incremental increases in the probability for severe or extensive C AD both as a function of prescan likelihood of CAD and summed stress s core. A severely abnormal scan (summed stress score >8) during adenosi ne technetium-99m sestamibi myocardial perfusion SPECT had a high sens itivity of 91% and a moderately high specificity of 70% for identifyin g high-risk women with severe or extensive CAD. These results coupled with the previously defined prognostic significance of these findings suggest this test to be a useful diagnostic tool for the evaluation of CAD in women. (C) 1997 by Excerpta Medico, Inc.