Abstract 13722: Sex-Related Differences in the Yield of Myocardial Perfusion Imaging (MPI) in Patients Referred from the Emergency Department (ED) after Serial Negative Troponins
Introduction: Women with possible ACS can present with atypical symptoms and are often referred for routine provocative testing, though the yield of testing is uncertain.
Methods: We identified consecutive patients from the ED who had MPI after negative troponin tests. We assessed death, angiography, and revascularization at 30 days.
Results: Among 5,354 patients, 3,144 (58.7%) were female (59.5 ± 13.5 years). Women had fewer co-morbidities compared to men (CAD: 17.2% v. 31.4%, p < 0.001; hyperlipidemia: 53.3% v 56.4%, p = 0.03; smoking: 18.7% v. 24.6%, <0.001). Men ≤ 65 had a trend for increased incidence of ischemia compared to women ≤ 65 (15.7% v. 12.4%, p = 0.06). When stratified by TIMI score, men with TIMI scores of 0-1 were significantly more likely to have ischemia than women, but this sex-related difference was attenuated with increasing TIMI scores and was not significantly different for TIMI scores ≤ 2 (Fig 1). Among 479 patients with ischemia, 356 (74.3%) had angiography. In these patients, women were less likely to have obstructive CAD compared to men (58.8% v. 45.4%, p = 0.01), though there was no significant difference in patients with higher TIMI scores (Fig 2). At 30 days, 2 (0.06%) women were deceased, and 73 (2.3%) women had revascularization, including 3 (0.1%) women with myocardial infarctions.
Conclusions: In ED patients, the yield of MPI to detect ischemia and obstructive CAD is lower in women than men with TIMI scores < 2. For women with TIMI scores ≤ 3, the yield of MPI is modest and similar to men. However, the benefit of early risk stratification with MPI in any woman with serial negative troponins is uncertain given the low incidence of short-term adverse events.
Author Disclosures: P.C. Cremer: None. S. Khalaf: None. E. Mayer Sabik: None. V. Menon: None. M. Cerqueira: None. W. Jaber: None.
- © 2014 by American Heart Association, Inc.