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Appropriate use criteria for SPECT myocardial perfusion imaging: Are they appropriate for women?

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

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.

Methods and Results

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).

Conclusion

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.

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Abbreviations

AUC:

Appropriate use criteria

MPI:

Myocardial perfusion imaging

CAD:

Coronary artery disease

CHD:

Coronary heart disease

CI:

95% Confidence interval

HR:

Hazard ratio

LVEF:

Left ventricular ejection fraction

MACE:

Major adverse cardiac events

MI:

Myocardial infarction

OR:

Odds ratio

SDS:

Summed difference score

SPECT:

Single-photon emission computed tomography

SSS:

Summed stress score

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Disclosure

Rami Doukky serves on the Advisory Board for Astellas Pharma and receives research funding from Astellas Pharma. Other Authors have no conflicts to report.

Author information

Authors and Affiliations

  1. Division of Cardiology, John H. Stroger, Jr. Hospital of Cook County, 1901 W. Harrison St, Suite 3620, Chicago, 60612, IL, USA

    Rami Doukky MD, MSc, FACC, FANSC

  2. Division of Cardiology, Rush University Medical Center, Chicago, IL, USA

    Rami Doukky MD, MSc, FACC, FANSC, Kathleen Hayes MD & Nathan Frogge MD, MBA

  3. Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA

    Nathan Frogge MD, MBA

Authors
  1. Rami Doukky MD, MSc, FACC, FANSC
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  2. Kathleen Hayes MD
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  3. Nathan Frogge MD, MBA
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Corresponding author

Correspondence to Rami Doukky MD, MSc, FACC, FANSC.

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Funding

The original study leading to the formation of the study cohort was funded by an investigator initiated grant from Astellas Pharma US (Northbrook, IL). Grant fiduciary: Rush University Medical Center. Principal Investigator: Rami Doukky, MD. The funding source had no input in the study design, execution, data analysis and interpretation, or manuscript preparation and approval.

See related editorial, doi:10.1007/s12350-015-0271-8.

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Doukky, R., Hayes, K. & Frogge, N. Appropriate use criteria for SPECT myocardial perfusion imaging: Are they appropriate for women?. J. Nucl. Cardiol. 23, 695–705 (2016). https://doi.org/10.1007/s12350-015-0233-1

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  • DOI: https://doi.org/10.1007/s12350-015-0233-1

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