Myocardial Perfusion Proposed as First-Line Prognostic Test in Women


ORLANDO, FLA. — Myocardial perfusion imaging substantially restratifies women with a moderate or high Duke Treadmill Score on exercise stress testing, Justin B. Lundbye, M.D., said at the annual meeting of the American College of Cardiology.

“In this subset of women with intermediate to high pretest likelihood of coronary artery disease [CAD] based on Duke Treadmill Score, we feel that consideration should be given to utilization of exercise myocardial perfusion imaging as the first-line test,” asserted Dr. Lundbye of Hartford (Conn.) Hospital.

Current ACC/American Heart Association guidelines recommend exercise stress testing (EST) alone for women with an intermediate or high pretest probability of CAD. But because of the nature of EST, many women will have false-positive results. Perfusion imaging reliably subclassifies women into two groups: those who require further testing and those who do not, he said.

He reported on 1,020 women with an intermediate or high pretest likelihood of significant CAD who underwent EST and technetium-99 sestamibi myocardial perfusion imaging. During a mean 2.4 years of follow-up, women with a moderate Duke Treadmill Score of −10 to +4 (high risk to moderate risk) had a 3% annual rate of all-cause mortality, nonfatal MI, or coronary revascularization performed more than 2 months after their EST. In those who had an abnormal imaging study, the combined annual event rate was 17%. In those with a normal perfusion imaging study, it was 2%.

In women with a high-risk treadmill score of −11 or less, the annual event rate was 12%. Those with an abnormal perfusion scan had an annual event rate of 28%, while those with a negative scan had a rate of 4%.

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