Why the study?
To evaluate predictive models for major adverse cardiac events in women with abnormal summed difference score across different degrees of myocardial ischemia.
What are the predictive variables for major adverse cardiac events in women with different degrees of abnormal summed difference score on gSPECT-MPI?
What are the predictive variables for major adverse cardiac events in women with different degrees of abnormal summed difference score on gSPECT-MPI?
In women with abnormal myocardial perfusion imaging, the moderate-to-severe abnormal summed stress score is the most significant predictor of major adverse cardiac events.
Different SDS thresholds yield distinct MACE predictors in women; supports tailored models but leaves practice change open.
OBJECTIVE: Evaluating the predictive models (PM) for a major adverse cardiac event (MACE) only in women with abnormal summed difference score (SDS ≥ 1), borderline myocardial ischemia (borderline-MIsch: SDS = 1), MIsch (SDS ≥ 2), mild-MIsch (SDS = 2-4), and moderate-severe MIsch (ms-MIsch: SDS ≥ 5). METHODS: Between January 2000 and January 2018, of 25 943 consecutive patients who underwent gated single-photon emission computed tomography myocardial perfusion imaging (gSPECT-MPI) for coronary risk stratification; 717 women (age 68.37 ± 3.4 years) with an abnormal SDS ≥ 1 were included. During the follow-up (mean 4 ± 2.9 years) post-gSPECT-MPI, MACE (unstable angina, nonfatal myocardial infarction, coronary revascularization, cardiac death) was assessed. RESULTS: In the global women cohort with abnormal SDS ( n = 717), the PM was angina [hazard ratio (HR): 1.65, P = 0.016], diabetes (HR: 1.72, P = 0.004), beta-blockers (HR: 1.61, P = 0.009), pharmacological stress (HR: 1.74, P = 0.007), ↓ segment (ST) mm ≥ 1 (HR: 1.54, P = 0.039), and moderate-to-severe abnormal summed stress score (ms-SSS) (HR: 2.92, P = 0.001). In borderline-MIsch group ( n = 208), the PM was previous myocardial infarction (HR: 3.8, P = 0.001), nitrates (HR: 2.13, P = 0.047), pharmacological stress (HR: 4.81, P < 0.001), and ↓ST mm ≥ 1 (HR: 3.07, P = 0.014). In MIsch group ( n = 509), the PM model was ms-SSS (HR: 2.25, P = 0.001), diabetes (HR: 1.73, P = 0.011), angina (HR: 1.68, P = 0.029), beta-blockers (HR: 1.59, P = 0.026), and ms-MIsch (HR: 1.62, P = 0.044). In mild-MIsch group ( n = 399), the PM was ms-SSS (HR: 2.55, P = 0.003), diabetes (HR: 2.17, P = 0.004), angina (HR: 1.89, P = 0.037), and beta-blockers (HR: 2.01, P = 0.011). In ms-MIsch group ( n = 110), the predictive variable for MACE was ms-SSS (HR: 2.27, P = 0.016). The ms-SSS significantly increases the prognostic value of the ms-MIsch ( P = 0.001). CONCLUSION: Women with different degrees of abnormal SDS have different PMs of MACE. The ms-SSS stands out as the most significant predictive variable.
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Romero-Farina et al. (2024) studied this question.
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