Prognostic value of positive ergometry with normal myocardial perfusion SPECT. Are there differences in the analysis by sex?

Abstract

The discrepancy between the result of stress test and perfusion imaging sets a complex scenario. The signs of ischemia in stress test could jeopardize the negative predictive value of a normal SPECT MPI. Objective: to determine the incidence of events in the follow-up of
these patients, and to analyze them comparatively by gender. A retrospective cohort study was performed, including patients who had presented signs of ischemia in ergometry, with normal perfusion. Those who had previous coronary artery disease or any other heart disease that could operate as a confounding variable, were excluded. The result variable was defined as a combined endpoint of non-fatal infarction and/or cardiovascular death and/or revascularization. There were 217 patients (54% women, 64±9 years) analyzed. In relation to cardiovascular risk factors, 78% had high blood pressure and 22% diabetes. After an average of 3 years of follow-up, 4 patients (1.8%) died of cardiovascular causes (2 men, 2 women), and 6 (2.7%) had non-fatal heart attacks (3 men and 3 women). In addition, 37 patients (17% of the total) received elective revascularizations (64% men). Infarction-free survival within 1 year was 98.1%, and within 3 years 95.7%, with no statistically significant difference between men and
women. Conclusion: Patients with positive stress test and normal myocardial perfusion SPECT have good survival within three years of follow-up, but with a not minor incidence of non-fatal infarction and elective coronary revascularization. No significant differences were observed in the incidence of cardiovascular death and non-fatal infarction in both genders.