The noninvasive prediction of cardiac mortality in men and women with known or suspected coronary artery disease

Thomas H. Marwick, Leslee J. Shaw, Michael S. Lauer, Karen Kesler, Rory Hachamovitch, Gary V. Heller, Mark I. Travin, Salvatore Borges-Neto, Daniel S. Berman, Donald D Miller

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Abstract

PURPOSE: The association between myocardial per fusion imaging defects and cardiac mortality in women is undefined. We examined whether myocardial perfusion imaging predicted cardiac mortality in men and women and compared this with other variables influencing prognosis. SUBJECTS AND METHODS: Six academic institutions with high-volume nuclear cardiology laboratories consecutively studied 5,009 men aged 62 ± 12 years (mean ISD) and 3,402 women aged 66 ± 11 years with symptomatic known or suspected coronary artery disease undergoing exercise (n = 7,486) or pharmacologic stress (n = 925) myocardial perfusion imaging. A pretest clinical risk index was calculated from age, history of myocardial infarction, diabetes, hypertension, and hypercholesterolemia. Myocardial perfusion images were analyzed for stress- induced defects or any defect in the territories of the three major coronary arteries. RESULTS: Stress-induced perfusion defects were seen in 39% of men and 25% of women (P = 0.0001). Extensive stress-induced or fixed defects (>2 vascular territories) were less common in women than men (10% vs 19%, and 4% vs 18%, both P = 0.0001). During a mean of 2.4 ± 1.5 years of follow-up, 143 patients died of cardiac causes. The clinical risk index and number of territories with perfusion defects were associated with cardiac mortality in women and men. In women undergoing exercise myocardial perfusion imaging, the number of abnormal territories remained the strongest correlate of mortality after adjustment for exercise variables. CONCLUSIONS: The results of myocardial perfusion imaging are important, independent predictors of survival in both women and men.

Original languageEnglish (US)
Pages (from-to)172-178
Number of pages7
JournalAmerican Journal of Medicine
Volume106
Issue number2
DOIs
StatePublished - Feb 1 1999
Externally publishedYes

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Coronary Artery Disease
Myocardial Perfusion Imaging
Mortality
Perfusion
Exercise
Hypercholesterolemia
Cardiology
Blood Vessels
Coronary Vessels
Myocardial Infarction
Hypertension
Survival

ASJC Scopus subject areas

  • Medicine(all)

Cite this

The noninvasive prediction of cardiac mortality in men and women with known or suspected coronary artery disease. / Marwick, Thomas H.; Shaw, Leslee J.; Lauer, Michael S.; Kesler, Karen; Hachamovitch, Rory; Heller, Gary V.; Travin, Mark I.; Borges-Neto, Salvatore; Berman, Daniel S.; Miller, Donald D.

In: American Journal of Medicine, Vol. 106, No. 2, 01.02.1999, p. 172-178.

Research output: Contribution to journalArticle

Marwick, TH, Shaw, LJ, Lauer, MS, Kesler, K, Hachamovitch, R, Heller, GV, Travin, MI, Borges-Neto, S, Berman, DS & Miller, DD 1999, 'The noninvasive prediction of cardiac mortality in men and women with known or suspected coronary artery disease', American Journal of Medicine, vol. 106, no. 2, pp. 172-178. https://doi.org/10.1016/S0002-9343(98)00388-X
Marwick, Thomas H. ; Shaw, Leslee J. ; Lauer, Michael S. ; Kesler, Karen ; Hachamovitch, Rory ; Heller, Gary V. ; Travin, Mark I. ; Borges-Neto, Salvatore ; Berman, Daniel S. ; Miller, Donald D. / The noninvasive prediction of cardiac mortality in men and women with known or suspected coronary artery disease. In: American Journal of Medicine. 1999 ; Vol. 106, No. 2. pp. 172-178.
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AU - Shaw, Leslee J.

AU - Lauer, Michael S.

AU - Kesler, Karen

AU - Hachamovitch, Rory

AU - Heller, Gary V.

AU - Travin, Mark I.

AU - Borges-Neto, Salvatore

AU - Berman, Daniel S.

AU - Miller, Donald D

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N2 - PURPOSE: The association between myocardial per fusion imaging defects and cardiac mortality in women is undefined. We examined whether myocardial perfusion imaging predicted cardiac mortality in men and women and compared this with other variables influencing prognosis. SUBJECTS AND METHODS: Six academic institutions with high-volume nuclear cardiology laboratories consecutively studied 5,009 men aged 62 ± 12 years (mean ISD) and 3,402 women aged 66 ± 11 years with symptomatic known or suspected coronary artery disease undergoing exercise (n = 7,486) or pharmacologic stress (n = 925) myocardial perfusion imaging. A pretest clinical risk index was calculated from age, history of myocardial infarction, diabetes, hypertension, and hypercholesterolemia. Myocardial perfusion images were analyzed for stress- induced defects or any defect in the territories of the three major coronary arteries. RESULTS: Stress-induced perfusion defects were seen in 39% of men and 25% of women (P = 0.0001). Extensive stress-induced or fixed defects (>2 vascular territories) were less common in women than men (10% vs 19%, and 4% vs 18%, both P = 0.0001). During a mean of 2.4 ± 1.5 years of follow-up, 143 patients died of cardiac causes. The clinical risk index and number of territories with perfusion defects were associated with cardiac mortality in women and men. In women undergoing exercise myocardial perfusion imaging, the number of abnormal territories remained the strongest correlate of mortality after adjustment for exercise variables. CONCLUSIONS: The results of myocardial perfusion imaging are important, independent predictors of survival in both women and men.

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