To assess the ability of adenosine technetium-99m sestamibi myocardial perfusion single-photon
emission computed tomography (SPECT) to identify high-risk women with severe or extensive
coronary artery disease (CAD), we studied 130 consecutive women who underwent adenosine
sestamibi myocardial perfusion SPECT and catheterization within 2 months. Severe (>
or = 50% stenosis of left main coronary artery, > or = 90% stenosis in the proximal
left anterior descending or in > or = 2 coronary arteries) or extensive (> or = 70%
stenosis in 3 vessels) CAD was present in 54 patients, whereas 76 had no CAD or mild
to moderate CAD. Semiquantitative visual SPECT analysis used 20 segments and a 5-point
scoring system (0 = normal, 4 = absent uptake). Among the clinical, hemodynamic and
nuclear variables analyzed, univariate predictors of severe or extensive CAD included
a higher prescan likelihood of CAD, history of myocardial infarction, a higher heart
rate at rest, a lower increase in heart rate during adenosine infusion, a higher summed
stress score, summed reversibility score, and multivessel scan abnormality. Multivariate
logistic analysis of the most predictive clinical (prescan likelihood of CAD), hemodynamic
(increase in heart rate during adenosine infusion), and scan variables (summed stress
score) revealed summed stress score (chi-square = 32; p <0.0001) and prescan likelihood
of CAD (chi-square = 6.4; p <0.05) as the only independent predictors of severe or
extensive CAD. Based on these logistic models, we determined the probability for the
presence of severe or extensive CAD in patients with low, intermediate, and high prescan
likelihood of CAD across the range of values of a summed stress score. This revealed
that there were incremental increases in the probability for severe or extensive CAD
both as a function of prescan likelihood of CAD and summed stress score. A severely
abnormal scan (summed stress score > 8) during adenosine technetium-99m sestamibi
myocardial perfusion SPECT had a high sensitivity of 91% and a moderately high specificity
of 70% for identifying high-risk women with severe or extensive CAD. These results
coupled with the previously defined prognostic significance of these findings suggest
this test to be a useful diagnostic tool for the evaluation of CAD in women.