The Role of Myocardial Perfusion Imaging in the Clinical Evaluation of Coronary Artery Disease in Women

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Citation
US Cardiology, 2006;3(1):66-70

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The American Society of Nuclear Cardiology (ASNC), founded in 1993, is a professional medical society whose mission is to foster optimal delivery of nuclear cardiology services through professional education and leadership in the establishment of standards and guidelines for the practice of nuclear cardiology. ASNC will from time to time publish Position, Policy or Consensus Statements, which reflect a body of knowledge and clinical evidence for an application of radionuclide imaging techniques in the clinical care of patients with known or suspected heart disease. Position, Policy or Consensus Statements are approved by the ASNC Board of Directors prior to publication.

This Consensus Statement will examine the role of myocardial perfusion imaging studies in the diagnosis, risk assessment and treatment of women with known or suspected coronary artery disease (CAD).

Background

Cardiovascular disease is the leading cause of death of women in the US. Despite advances in its diagnosis and management, CAD continues to claim the lives of more than 230,000 American women each year. The lifetime risk of cardiovascular disease and its ensuing complications is 25% for a 40-year-old woman but increases to nearly 50% for older women. Prior to the last decade, under-representation of women in clinical trials and observational studies has led to a lack of available evidence and a generalized misperception that CAD was a 'manÔÇÖs disease.ÔÇÖ As a result of a paucity of clinical evidence on diagnosis and treatment of CAD, the ensuing management patterns for women have been exceedingly inefficient. There is an abundance of evidence on under-recognition, under-diagnosis and under-treatment of coronary disease in women, contributing to higher cardiovascular mortality. Increased mortality has been repeatedly noted in women after myocardial infarction, where 38% of women as compared to 25% of men will die within one year after hospitalization. These data support a worse prognosis for women with CAD compared to men.

We believe that one key to affecting significant changes in cardiovascular mortality for women is the appropriate use of a highly accurate diagnostic test, such as gated myocardial perfusion single positron emission computed tomography (SPECT), which results in early and effective treatment and improved outcome for at-risk women. The current document aims to put forth a synopsis of available evidence on the role of myocardial perfusion imaging studies in women.

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