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

Leslee J. Shaw, Jennifer H. Mieres, Robert Hendel, William E. Boden, Martha Gulati, Emir Veledar, Rory Hachamovitch, James A. Arrighi, C. Noel Bairey Merz, Raymond J. Gibbons, Nanette K. Wenger, Gary V. Heller

Research output: Contribution to journalArticle

170 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)1239-1249
Number of pages11
JournalCirculation
Volume124
Issue number11
DOIs
StatePublished - Sep 13 2011

Fingerprint

Single-Photon Emission-Computed Tomography
Exercise Test
Coronary Artery Disease
Electrocardiography
Ischemia
Perfusion
Exercise
Myocardial Perfusion Imaging
Cost Savings
Metabolic Equivalent
Costs and Cost Analysis
Acute Coronary Syndrome

Keywords

  • Clinical trials
  • diagnostic testing
  • exercise testing
  • physical capacity
  • women

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

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. / Shaw, Leslee J.; Mieres, Jennifer H.; Hendel, Robert; Boden, William E.; Gulati, Martha; Veledar, Emir; Hachamovitch, Rory; Arrighi, James A.; Merz, C. Noel Bairey; Gibbons, Raymond J.; Wenger, Nanette K.; Heller, Gary V.

In: Circulation, Vol. 124, No. 11, 13.09.2011, p. 1239-1249.

Research output: Contribution to journalArticle

Shaw, Leslee J. ; Mieres, Jennifer H. ; Hendel, Robert ; Boden, William E. ; Gulati, Martha ; Veledar, Emir ; Hachamovitch, Rory ; Arrighi, James A. ; Merz, C. Noel Bairey ; Gibbons, Raymond J. ; Wenger, Nanette K. ; Heller, Gary V. / 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. In: Circulation. 2011 ; Vol. 124, No. 11. pp. 1239-1249.
@article{900456d57b5d499187982556a5f6064c,
title = "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",
abstract = "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.",
keywords = "Clinical trials, diagnostic testing, exercise testing, physical capacity, women",
author = "Shaw, {Leslee J.} and Mieres, {Jennifer H.} and Robert Hendel and Boden, {William E.} and Martha Gulati and Emir Veledar and Rory Hachamovitch and Arrighi, {James A.} and Merz, {C. Noel Bairey} and Gibbons, {Raymond J.} and Wenger, {Nanette K.} and Heller, {Gary V.}",
year = "2011",
month = "9",
day = "13",
doi = "10.1161/CIRCULATIONAHA.111.029660",
language = "English",
volume = "124",
pages = "1239--1249",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "11",

}

TY - JOUR

T1 - Comparative effectiveness of exercise electrocardiography with or without myocardial perfusion single photon emission computed tomography in women with suspected coronary artery disease

T2 - Results from the what is the optimal method for ischemia evaluation in women (WOMEN) trial

AU - Shaw, Leslee J.

AU - Mieres, Jennifer H.

AU - Hendel, Robert

AU - Boden, William E.

AU - Gulati, Martha

AU - Veledar, Emir

AU - Hachamovitch, Rory

AU - Arrighi, James A.

AU - Merz, C. Noel Bairey

AU - Gibbons, Raymond J.

AU - Wenger, Nanette K.

AU - Heller, Gary V.

PY - 2011/9/13

Y1 - 2011/9/13

N2 - 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.

AB - 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.

KW - Clinical trials

KW - diagnostic testing

KW - exercise testing

KW - physical capacity

KW - women

UR - http://www.scopus.com/inward/record.url?scp=80052777152&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80052777152&partnerID=8YFLogxK

U2 - 10.1161/CIRCULATIONAHA.111.029660

DO - 10.1161/CIRCULATIONAHA.111.029660

M3 - Article

C2 - 21844080

AN - SCOPUS:80052777152

VL - 124

SP - 1239

EP - 1249

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 11

ER -