title: Adenosine myocardial perfusion single-photon emission computed tomography in women compared with men. Impact of diabetes mellitus on incremental prognostic value and effect on patient management.
abstract: OBJECTIVE
  This study was designed to assess the incremental prognostic value of adenosine stress myocardial perfusion single-photon emission computed tomography (MPS) in women versus men, and to explore the prognostic impact of diabetes mellitus.
  
  
  BACKGROUND
  Limited data are available regarding the incremental value of adenosine stress MPS for the prediction of cardiac death in women versus men and the impact of diabetes mellitus on post-adenosine MPS outcomes. Of 6,173 consecutive patients who underwent rest thallium-201/adenosine technetium-99m sestamibi MPS, 254 (4.1%) were lost to follow-up, and 586 with early revascularization < or = 60 days after MPS were censored, leaving 2,656 women and 2,677 men.
  
  
  RESULTS
  Women had significantly smaller adenosine stress, rest, and reversible defects than men. During 27.0 +/- 8.8 month follow-up, cardiac death rates were lower in women than men (2.0%/year vs. 2.7%/year, respectively, p < 0.05). Before and after risk adjustment, cardiac death risk increased significantly in both men and women as a function of MPS results. Multivariable models revealed that MPS results provided incremental prognostic value over pre-scan data for the prediction of cardiac death in both genders. Also, while comparative unadjusted rates of early (< or =60 days post-test) coronary angiography (17% vs. 23%) and revascularization (8% vs. 12%) were significantly lower in women (p < 0.05), after adjusting for MPS, these rates were similar in men and women. Importantly, diabetic women had a significantly greater risk of cardiac death compared with other patients. Also, after risk adjustment, patients with insulin-dependent diabetes mellitus (IDDM) had higher risk of cardiac death for any MPS result than patients with non-insulin-dependent diabetes mellitus.
  
  
  CONCLUSIONS
  The findings suggest that adenosine MPS has comparable incremental value for prediction of cardiac death in women and men and that MPS is appropriately influencing subsequent invasive management decisions in both genders. Diabetic women and patients with IDDM appear to have greater risk of cardiac death than other patients for any MPS result.
authors.affiliation: Department of Imaging, Division of Nuclear Medicine, and CSMC Burns and Allen Research Institute, Cedars-Sinai Medical Center, University of California Los Angeles, School of Medicine, Los Angeles, California 90048, USA. bermand@cshs.org
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
authors.forename: Xingping
authors.initials: X
authors.lastname: Kang
authors.forename: Sean W
authors.initials: SW
authors.lastname: Hayes
authors.forename: John D
authors.initials: JD
authors.lastname: Friedman
authors.forename: Ishac
authors.initials: I
authors.lastname: Cohen
authors.forename: Aiden
authors.initials: A
authors.lastname: Abidov
authors.forename: Leslee J
authors.initials: LJ
authors.lastname: Shaw
authors.forename: Aman M
authors.initials: AM
authors.lastname: Amanullah
authors.forename: Guido
authors.initials: G
authors.lastname: Germano
authors.forename: Rory
authors.initials: R
authors.lastname: Hachamovitch
mesh_terms: D000241:Adenosine; D000368:Aged; D015331:Cohort Studies; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality; D016757:Death, Sudden, Cardiac / Q000209:etiology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality; D004562:Electrocardiography; D005080:Exercise Test / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D016019:Survival Analysis; D017256:Technetium Tc 99m Sestamibi; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014665:Vasodilator Agents
chemical_list: D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes; D014665:Vasodilator Agents; D017256:Technetium Tc 99m Sestamibi; D000241:Adenosine