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Differences in Prognostic Value of Myocardial Perfusion Single-Photon Emission Computed Tomography Using High-Efficiency Solid-State Detector Between Men and Women in a Large International Multicenter Study

Originally publishedhttps://doi.org/10.1161/CIRCIMAGING.121.012741Circulation: Cardiovascular Imaging. 2022;15

    Background:

    Semiquantitative assessment of stress myocardial perfusion defect has been shown to have greater prognostic value for prediction of major adverse cardiac events (MACE) in women compared with men in single-center studies with conventional single-photon emission computed tomography (SPECT) cameras. We evaluated sex-specific difference in the prognostic value of automated quantification of ischemic total perfusion defect (ITPD) and the interaction between sex and ITPD using high-efficiency SPECT cameras with solid-state detectors in an international multicenter imaging registry (REFINE SPECT [Registry of Fast Myocardial Perfusion Imaging With Next-Generation SPECT]).

    Methods:

    Rest and exercise or pharmacological stress SPECT myocardial perfusion imaging were performed in 17 833 patients from 5 centers. MACE was defined as the first occurrence of death or myocardial infarction. Total perfusion defect (TPD) at rest, stress, and ejection fraction were quantified automatically by software. ITPD was given by stressTPD-restTPD. Cox proportional hazards model was used to evaluate the association between ITPD versus MACE-free survival and expressed as a hazard ratio.

    Results:

    In 10614 men and 7219 women, with a median follow-up of 4.75 years (interquartile range, 3.7–6.1), there were 1709 MACE. In a multivariable Cox model, after adjusting for revascularization and other confounding variables, ITPD was associated with MACE (hazard ratio, 1.08 [95% CI, 1.05–1.1]; P<0.001). There was an interaction between ITPD and sex (P<0.001); predicted survival for ITPD<5% was worse among men compared to women, whereas survival among women was worse than men for ITPD≥5%, P<0.001.

    Conclusions:

    In the international, multicenter REFINE SPECT registry, moderate and severe ischemia as quantified by ITPD from high-efficiency SPECT is associated with a worse prognosis in women compared with men.

    Footnotes

    *B.K. Tamarappoo and Y. Otaki contributed equally.

    This manuscript was sent to Linda D. Gillam, MD, MPH, Senior Guest Editor, for review by expert referees, editorial decision, and final disposition

    Supplemental Material is available at https://www.ahajournals.org/doi/suppl/10.1161/CIRCIMAGING.121.012741.

    For Sources of Funding and Disclosures, see page 370.

    Correspondence to: Piotr Slomka, PhD, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. Metro 203, Los Angeles, California 90048. Email

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