title: No gender bias in referral for coronary angiography after myocardial perfusion scintigraphy with technetium-99m tetrofosmin.
abstract: BACKGROUND
  Several studies have shown that the application of diagnostic and invasive procedures varies between men and women. The purpose of this study was to assess if referral for coronary angiography after technetium-99m tetrofosmin myocardial perfusion scintigraphy in 616 patients with undiagnosed chest pain might demonstrate gender bias.
  
  
  RESULTS
  The primary end point for this study was coronary angiography within 90 days of myocardial perfusion scintigraphy. Women had more normal perfusion images than men (207 [70.9%] vs 160 [50.5%], P < .05). Of 242 patients with abnormal images (157 men, 85 women), 28 men (17.7%) and 17 women (20.0%) were referred for further invasive testing (P = not significant). Referral for coronary angiography increased relative to the number of defects. Univariate analysis showed that reversible and persistent defects were the most predictive variables for referral to coronary angiography (odds ratio [OR] 5.45, 95% confidence interval [CI] 3.10-9.58, P < .001, and OR 2.67, 95% CI 1.52-4.67, P = .001, respectively). More importantly, multivariate analysis showed that reversible perfusion defects (OR 4.77, 95% CI 2.48-9.17, P < .001) and persistent perfusion defects (OR 2.14, 95% CI 1.11-4.14, P = .02) were predictive of subsequent coronary angiography. No significant association between gender and subsequent coronary angiography was found both in univariate and multivariate logistic regression analysis (OR 0.64, 95% CI 0.37-1.12, P = .12, and OR 0.70, 95% CI 0.36-1.36, P = .28, respectively).
  
  
  CONCLUSIONS
  Our study reveals that after correction for the presence and the severity of myocardial perfusion abnormalities, men and women were referred to coronary angiography at a similar rate. Thus, based on the results of technetium-99m tetrofosmin myocardial perfusion imaging, no substantial evidence for a gender-related bias could be found in the referral for further invasive testing.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, The Netherlands.
authors.forename: J E
authors.initials: JE
authors.lastname: Roeters van Lennep
authors.forename: J J
authors.initials: JJ
authors.lastname: Borm
authors.forename: A H
authors.initials: AH
authors.lastname: Zwinderman
authors.forename: E K
authors.initials: EK
authors.lastname: Pauwels
authors.forename: A V
authors.initials: AV
authors.lastname: Bruschke
authors.forename: E E
authors.initials: EE
authors.lastname: van der Wall
mesh_terms: D000704:Analysis of Variance; D000787:Angina Pectoris / Q000000981:diagnostic imaging*; D016001:Confidence Intervals; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology; D003327:Coronary Disease / Q000000981:diagnostic imaging; D005080:Exercise Test; D005260:Female; D005544:Forecasting; D006801:Humans; D007091:Image Processing, Computer-Assisted; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D011287:Prejudice; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012017:Referral and Consultation; D012737:Sex Factors; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C078700:technetium tc-99m tetrofosmin