首页> 外文期刊>Circulation: An Official Journal of the American Heart Association >Comparative effectiveness of exercise electrocardiography with or without myocardial perfusion single photon emission computed tomography in women with suspected coronary artery disease: results from the What Is the Optimal Method for Ischemia Evaluation in Women (WOMEN) trial.
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Comparative effectiveness of exercise electrocardiography with or without myocardial perfusion single photon emission computed tomography in women with suspected coronary artery disease: results from the What Is the Optimal Method for Ischemia Evaluation in Women (WOMEN) trial.

机译:运动性心电图在有或没有心肌灌注的单次光子发射计算机体层摄影术中对可疑冠状动脉疾病的女性患者的比较效果:来自“女性缺血评估的最佳方法是什么”(WOMEN)试验的结果。

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BACKGROUND: There is a paucity of randomized trials regarding diagnostic testing in women with suspected coronary artery disease (CAD). It remains unclear whether the addition of myocardial perfusion imaging (MPI) to the standard ECG exercise treadmill test (ETT) provides incremental information to improve clinical decision making in women with suspected CAD. METHODS AND RESULTS: We randomized symptomatic women with suspected CAD, an interpretable ECG, and >/=5 metabolic equivalents on the Duke Activity Status Index to 1 of 2 diagnostic strategies: ETT or exercise MPI. The primary end point was 2-year incidence of major adverse cardiac events, defined as CAD death or hospitalization for an acute coronary syndrome or heart failure. A total of 824 women were randomized to ETT or exercise MPI. For women randomized to ETT, ECG results were normal in 64%, indeterminate in 16%, and abnormal in 20%. By comparison, the exercise MPI results were normal in 91%, mildly abnormal in 3%, and moderate to severely abnormal in 6%. At 2 years, there was no difference in major adverse cardiac events (98.0% for ETT and 97.7% for MPI; P=0.59). Compared with ETT, index testing costs were higher for exercise MPI (P<0.001), whereas downstream procedural costs were slightly lower (P=0.0008). Overall, the cumulative diagnostic cost savings was 48% for ETT compared with exercise MPI (P<0.001). CONCLUSIONS: In low-risk, exercising women, a diagnostic strategy that uses ETT versus exercise MPI yields similar 2-year posttest outcomes while providing significant diagnostic cost savings. The ETT with selective follow-up testing should be considered as the initial diagnostic strategy in symptomatic women with suspected CAD. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT00282711.
机译:背景:关于可疑冠状动脉疾病(CAD)妇女诊断测试的随机试验很少。目前尚不清楚标准的ECG运动跑步机测试(ETT)中是否增加了心肌灌注显像(MPI)是否可以提供增量信息,以改善可疑CAD患者的临床决策。方法和结果:我们将有症状的可疑CAD,可解释的心电图和Duke活动状态指数上> / = 5代谢当量的有症状女性随机分为2种诊断策略之一:ETT或运动MPI。主要终点为严重不良心脏事件的2年发生率,定义为CAD死亡或急性冠状动脉综合征或心力衰竭住院。总共824名妇女被随机分配至ETT或进行MPI锻炼。对于随机分配给ETT的女性,心电图检查结果正常(64%),不确定(16%)和异常(20%)。相比之下,运动MPI结果为正常的占91%,轻度异常的占3%,中度至重度异常的占6%。在2年时,主要的不良心脏事件没有差异(ETT发生率为98.0%,MPI发生率为97.7%; P = 0.59)。与ETT相比,锻炼MPI的指数测试成本更高(P <0.001),而下游手术成本则更低(P = 0.0008)。总体而言,与锻炼MPI相比,ETT的累计诊断成本节省为48%(P <0.001)。结论:在低风险,运动女性中,使用ETT与运动MPI的诊断策略可产生相似的2年测试后结果,同时可节省大量诊断成本。对于有可疑CAD的有症状女性,应将ETT与选择性的随访检查相结合,作为最初的诊断策略。临床试验注册:http://www.clinicaltrials.gov。唯一标识符:NCT00282711。

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