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.
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.
Travin
M I
MI
Division of Cardiology, Roger Williams Medical Center, Providence, R.I. 02908, USA.
Duca
M D
MD
Kline
G M
GM
Herman
S D
SD
Demus
D D
DD
Heller
G V
GV
D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000209:etiology; D000789:Angina, Unstable / Q000209:etiology; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016757:Death, Sudden, Cardiac / Q000209:etiology; D004176:Dipyridamole; D005080:Exercise Test / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D011237:Predictive Value of Tests; D011379:Prognosis; D019275:Radiopharmaceuticals; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012044:Regression Analysis; D015983:Selection Bias; D012723:Sex; D012737:Sex Factors; D013312:Stress, Physiological / Q000503:physiopathology; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon; D014665:Vasodilator Agents
D019275:Radiopharmaceuticals; D014665:Vasodilator Agents; D004176:Dipyridamole; D017256:Technetium Tc 99m Sestamibi