title: Appropriate use criteria for SPECT myocardial perfusion imaging: Are they appropriate for women?
abstract: Several studies have reported that women are more likely to receive inappropriate SPECT myocardial perfusion imaging (MPI), suggesting gender disparity in AUC determination. We investigated the impact of gender on the diagnostic and prognostic utility of AUC.
  
  
  
  We analyzed a multi-site prospective cohort of 1511 consecutive patients (43.5% women) who underwent outpatient, community-based SPECT-MPI. Subjects were stratified into gender groups and appropriateness subgroups, and followed for 27 ± 10 months for cardiac death, myocardial infarction, and coronary revascularization. Women were more likely to receive inappropriate MPI (60.7% vs 33.8%, P < .001). Irrespective of appropriateness, women were less likely to have an abnormal MPI (6.1% vs 14.9%, P < .001), even after adjusting for clinical covariates [odds ratio = 0.40 (95% confidence interval = 0.26-0.60), P < .001]. Irrespective of appropriateness, women were at lower risk for MACE (composite of cardiac death, myocardial infarction, or coronary revascularization) after adjusting for clinical and imaging covariates [hazard ratio = 0.49 (95% confidence interval = 0.28-0.86), P = .01]. There was no interaction between gender and appropriateness group as a determinant of abnormal MPI or MACE (interaction P values ≥ .26), indicating that female gender was associated with similar relative risk of an abnormal MPI and MACE irrespective of appropriateness group. Abnormal MPI was similarly predictive of increased hazard of MACE in both genders, regardless of appropriateness (interaction P values ≥ .46).
  
  
  
  In this multi-site cohort, there was no demonstrable gender-based differential impact of AUC on the diagnostic or prognostic utility of SPECT-MPI. The study validates the methods used in determining risk in the AUC algorithm and endorses the widespread application of AUC in men and women.
authors: Division of Cardiology, John H. Stroger, Jr. Hospital of Cook County, 1901 W. Harrison St, Suite 3620, Chicago, 60612, IL, USA. rami_doukky@rush.edu.|Division of Cardiology, Rush University Medical Center, Chicago, IL, USA. rami_doukky@rush.edu.
authors: Rami
authors: R
authors: Doukky
authors: Division of Cardiology, Rush University Medical Center, Chicago, IL, USA.
authors: Kathleen
authors: K
authors: Hayes
authors: Division of Cardiology, Rush University Medical Center, Chicago, IL, USA.|Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA.
authors: Nathan
authors: N
authors: Frogge
mesh_terms: D002641:Chicago / Q000453:epidemiology; D015331:Cohort Studies; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000401:mortality*; D055414:Myocardial Perfusion Imaging / Q000592:standards / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D063507:Sexism / Q000706:statistics & numerical data*; D015996:Survival Rate; D015899:Tomography, Emission-Computed, Single-Photon / Q000592:standards / Q000706:statistics & numerical data*; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D014600:Utilization Review; D016387:Women's Health / Q000592:standards / Q000706:statistics & numerical data*
keywords: SPECT; appropriate use criteria (AUC); gender disparity; myocardial perfusion imaging (MPI); outcome; women