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

Daniel S. Berman, Xingping Kang, Sean W. Hayes, John D. Friedman, Ishac Cohen, Aiden Abidov, Leslee J. Shaw, Aman M. Amanullah, Guido Germano, Rory Hachamovitch

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Abstract

OBJECTIVES: 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. METHODS: 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 ≤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 (≤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.

Original languageEnglish (US)
Pages (from-to)1125-1133
Number of pages9
JournalJournal of the American College of Cardiology
Volume41
Issue number7
DOIs
StatePublished - Apr 2 2003
Externally publishedYes

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Single-Photon Emission-Computed Tomography
Adenosine
Diabetes Mellitus
Perfusion
Risk Adjustment
Type 1 Diabetes Mellitus
Technetium Tc 99m Sestamibi
Thallium
Lost to Follow-Up
Coronary Angiography
Type 2 Diabetes Mellitus
Mortality

ASJC Scopus subject areas

  • Nursing(all)

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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. / Berman, Daniel S.; Kang, Xingping; Hayes, Sean W.; Friedman, John D.; Cohen, Ishac; Abidov, Aiden; Shaw, Leslee J.; Amanullah, Aman M.; Germano, Guido; Hachamovitch, Rory.

In: Journal of the American College of Cardiology, Vol. 41, No. 7, 02.04.2003, p. 1125-1133.

Research output: Contribution to journalArticle

Berman, Daniel S. ; Kang, Xingping ; Hayes, Sean W. ; Friedman, John D. ; Cohen, Ishac ; Abidov, Aiden ; Shaw, Leslee J. ; Amanullah, Aman M. ; Germano, Guido ; Hachamovitch, Rory. / 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. In: Journal of the American College of Cardiology. 2003 ; Vol. 41, No. 7. pp. 1125-1133.
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abstract = "OBJECTIVES: 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. METHODS: 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 ≤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 (≤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.",
author = "Berman, {Daniel S.} and Xingping Kang and Hayes, {Sean W.} and Friedman, {John D.} and Ishac Cohen and Aiden Abidov and Shaw, {Leslee J.} and Amanullah, {Aman M.} and Guido Germano and Rory Hachamovitch",
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T1 - Adenosine myocardial perfusion single-photon emission computed tomography in women compared with men

T2 - Impact of diabetes mellitus on incremental prognostic value and effect on patient management

AU - Berman, Daniel S.

AU - Kang, Xingping

AU - Hayes, Sean W.

AU - Friedman, John D.

AU - Cohen, Ishac

AU - Abidov, Aiden

AU - Shaw, Leslee J.

AU - Amanullah, Aman M.

AU - Germano, Guido

AU - Hachamovitch, Rory

PY - 2003/4/2

Y1 - 2003/4/2

N2 - OBJECTIVES: 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. METHODS: 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 ≤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 (≤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.

AB - OBJECTIVES: 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. METHODS: 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 ≤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 (≤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.

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