title: Evaluating gender differences in prognosis following SPECT myocardial perfusion imaging among patients with diabetes and known or suspected coronary disease in the modern era.
abstract: BACKGROUND
  Previous data suggested that diabetic women were at greater risk for future cardiac events than diabetic men. Increasing awareness of coronary artery disease (CAD) in women and advances in the management of CAD may have changed this paradigm.
  
  
  OBJECTIVE
  To investigate gender differences in prognosis among patients with diabetes who were clinically referred for single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI).
  
  
  METHODS
  Patients with diabetes undergoing SPECT-MPI from 1996 to 2006 were followed for 5 years or until cardiac death or non-fatal myocardial infarction. Clinical characteristics and nuclear parameters were compared with χ (2) and t tests. Multivariable Cox regression controlled for baseline differences and tested the impact of gender on survival.
  
  
  RESULTS
  A total of 4,628 SPECT-MPI patients with diabetes (50% women, mean age 63 ± 12 years) were analyzed. There were 380 events, with rates higher in men (10% vs 7%, P < .001). Patients of either gender with abnormal scans had higher event rates than patients with normal scans. There were fewer cardiac events in diabetic females with no known CAD and normal scans compared to similar males (P = .044). However, diabetic males and females with known CAD had similar event rates for all degrees of perfusion abnormalities. Only age, history of heart failure, nuclear perfusion defect, and LVEF predicted survival; gender did not. LVEF ≤ 50% had the strongest association with cardiac events (hazard ratio = 2.518, 95% confidence interval, 1.922-3.298).
  
  
  CONCLUSIONS
  Cardiovascular outcomes among patients with diabetes, regardless of a history of CAD, were similar in women and men. The size and severity of stress-induced perfusion abnormalities predicted outcomes equally in both genders.
authors: Division of Cardiology, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT, 06030, USA, masantos@resident.uchc.edu.
authors: Maria Theresa H
authors: MT
authors: Santos
authors: Matthew W
authors: MW
authors: Parker
authors: Gary V
authors: GV
authors: Heller
mesh_terms: D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000209:etiology; D003920:Diabetes Mellitus / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012727:Sex Characteristics; D015899:Tomography, Emission-Computed, Single-Photon
references: JACC Cardiovasc Imaging. 2011 Aug;4(8):880-8
references: 21835380
references: Eur J Nucl Med Mol Imaging. 2006 Oct;33(10):1157-61
references: 16763814
references: Circulation. 2002 Jan 1;105(1):32-40
references: 11772873
references: JAMA. 1979 May 11;241(19):2035-8
references: 430798
references: Diabet Med. 2012 Apr;29(4):531-40
references: 21913966
references: Circulation. 1998 Feb 17;97(6):535-43
references: 9494023
references: JAMA. 1991 Feb 6;265(5):627-31
references: 1987413
references: J Am Coll Cardiol. 2003 Apr 2;41(7):1125-33
references: 12679212
references: J Nucl Cardiol. 2003 Jan-Feb;10(1):95-101
references: 12569338
references: J Am Coll Cardiol. 2002 Aug 21;40(4):588-603
references: 12204489
references: JACC Cardiovasc Imaging. 2011 Aug;4(8):924-5
references: 21835390
references: JACC Cardiovasc Imaging. 2011 Aug;4(8):850-61
references: 21835377
references: Eur Heart J. 2004 Apr;25(7):543-50
references: 15120050
references: Am J Med. 1996 Oct 8;101(4A):4A17S-22S; discussion 22S-24S
references: 8900333
references: Ann Intern Med. 2002 Mar 5;136(5):341-8
references: 11874305
references: Diabetes Care. 2000 Jul;23(7):962-8
references: 10895847
references: JAMA. 2009 Apr 15;301(15):1547-55
references: 19366774
references: Circulation. 2008 Jan 29;117(4):e25-146
references: 18086926
references: J Am Coll Cardiol. 2009 Oct 20;54(17):1561-75
references: 19833255
references: J Am Coll Cardiol. 2004 Jan 21;43(2):200-8
references: 14736438
references: J Nucl Cardiol. 2010 Oct;17(5):941-73
references: 20552312
references: JACC Cardiovasc Imaging. 2011 Jan;4(1):74-7
references: 21232707
references: Arch Intern Med. 2002 Aug 12-26;162(15):1737-45
references: 12153377
references: Can J Cardiol. 2006 Feb;22 Suppl A:22A-25A
references: 16485056
references: Circulation. 1978 Jan;57(1):133-6
references: 618380
references: J Nucl Cardiol. 2002 Mar-Apr;9(2):240-5
references: 11986572
references: Am Heart J. 1999 Dec;138(6 Pt 1):1025-32
references: 10577431
references: J Am Coll Cardiol. 1997 Jul;30(1):260-311
references: 9207652
references: Diab Vasc Dis Res. 2012 Apr;9(2):124-30
references: 22228772
references: J Am Coll Cardiol. 2002 Oct 16;40(8):1531-40
references: 12392846
references: J Nucl Cardiol. 2009 Jul-Aug;16(4):516-23
references: 19440807