Hachamovitch R, Berman D S, Kiat H, Bairey C N, Cohen I, Cabico A, Friedman J, Germano G, Van Train K F, Diamond G A
Department of Imaging (Division of Nuclear Medicine), Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
J Am Coll Cardiol. 1996 Jul;28(1):34-44. doi: 10.1016/0735-1097(96)00095-2.
This study was designed to evaluate the incremental prognostic value over clinical and exercise variables of rest thallium-201/exercise technetium-99m sestamibi single-photon emission computed tomography (SPECT) in women compared with men and to determine whether this test can be used to effectively risk stratify patients of both genders.
To minimize the previously described gender-related bias in the evaluation of coronary artery disease in women, there is a need to identify a noninvasive testing strategy that is able to accurately and effectively risk stratify women.
We identified 4,136 consecutive patients (2,742 men, 1,394 women) who underwent dual-isotope SPECT. The incremental value of nuclear testing was determined using both a stepwise Cox proportional hazards model and Kaplan-Meier survival analysis. Receiver operating characteristic curve analysis was performed to determine test discrimination for high risk patients in men and women.
The patient population was followed up for 20 +/- 5 months for events (cardiac death or nonfatal myocardial infarction). During this time, 63 myocardial infarctions and 32 cardiac deaths occurred in the men, and 31 myocardial infarctions and 14 cardiac deaths occurred in the women. Nuclear testing significantly stratified both men and women irrespective of their rest electrocardiogram. Cox proportional hazards analysis revealed that nuclear testing added incremental prognostic value in both men and women after inclusion of the most predictive clinical exercise variables (overall chi-square 89 in men vs. 120 in women, p < 0.005). Kaplan-Meier survival analysis demonstrated that nuclear testing further stratified men and women with both intermediate to high and low prescan likelihoods of coronary artery disease (p < 0.005 for all). Receiver operating characteristic curve analysis demonstrated superior discrimination for the nuclear scan results in identifying high risk women than men (area under the curve: 0.84 +/- 0.03 vs 0.71 +/- 0.03 in men, p < 0005). The odds ratio comparing event rates in patients with women than in men, suggesting superior stratification using nuclear testing in women.
Dual-isotope myocardial perfusion imaging yields incremental prognostic value in both men and women. This modality identifies low risk women and men equally well but relatively high risk women more accurately than relatively high risk men and, thus, is able to stratify women more effectively than men.
本研究旨在评估静息铊 - 201/运动锝 - 99m 司他米比单光子发射计算机断层扫描（SPECT）相对于临床和运动变量对女性和男性的增量预后价值，并确定该检查是否可用于对两性患者进行有效的风险分层。
为尽量减少先前描述的女性冠状动脉疾病评估中与性别相关的偏差，需要确定一种能够准确且有效地对女性进行风险分层的非侵入性检测策略。
我们纳入了 4136 例连续接受双同位素 SPECT 检查的患者（2742 名男性，1394 名女性）。使用逐步 Cox 比例风险模型和 Kaplan - Meier 生存分析来确定核素检测的增量价值。进行受试者操作特征曲线分析以确定该检查对男性和女性高危患者的区分能力。
对患者人群进行了 20±5 个月的事件随访（心脏死亡或非致命性心肌梗死）。在此期间，男性发生 63 例心肌梗死和 32 例心脏死亡，女性发生 31 例心肌梗死和 14 例心脏死亡。无论静息心电图情况如何，核素检测都能显著地对男性和女性进行分层。Cox 比例风险分析显示，在纳入最具预测性的临床运动变量后，核素检测在男性和女性中均增加了增量预后价值（男性总体卡方值为 89，女性为 120，p < 0.005）。Kaplan - Meier 生存分析表明，核素检测进一步对冠状动脉疾病预扫描可能性处于中高和低水平的男性和女性进行了分层（所有 p < 0.005）。受试者操作特征曲线分析表明，核素扫描结果在识别高危女性方面比男性具有更好的区分能力（曲线下面积：女性为 0.84±0.03，男性为 0.71±0.03，p < 0.005）。比较女性和男性患者事件发生率的优势比表明，使用核素检测对女性进行分层效果更好。
双同位素心肌灌注成像在男性和女性中均具有增量预后价值。这种检查方式对低风险的男性和女性识别效果相当，但对相对高风险女性的识别比相对高风险男性更准确，因此，与男性相比，它能够更有效地对女性进行分层。
