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Women with angina and myocardial SPECT perfusion defects but without significant epicardial coronary artery disease. Does a pathological SPECT result affect their long-term prognosis?

Evangelos Lampas, Kiriaki Syrmali, George T. Nikitas, Eirini Dri, Emmanouil C. Papadakis, Sotirios P. Patsilinakos

Background: Women with angina and a positive SPECT for reversible ischemia but without CAD or NOCAD on ICA often pose a significant concern in terms of prognosis.

Objectives and methods: A retrospective single center study assessing cardiovascular morbidity, mortality, and MACE in women with the above-mentioned characteristics during a follow-up period of at least three years after ICA using a telephone questionnaire.

Results: We retrospectively studied women with angina and a positive SPECT for reversible ischemia that underwent ICA for a period of 7 years (from January 1, 2011 until December 31, 2017) in our hospital. Women that fulfilled the pre-specified criteria were 189. At the telephone survey, 101 (53.4%) were successfully contacted and agreed to participate. The mean age was 69.2 (SD=8.4) years and the mean followup time was 5.51 years (SD=1.69). Mortality rate was 0.99% (1 patient yet of noncardiac causes) and 0.99% rate of revascularization (also 1 patient). Eight (7.9%) were hospitalized for cardiac reasons and 13 (12.8%) patients reported symptoms of HF (no women with NYHA-Class above II). Eight (7.9%) had arrhythmic events and only one (0.99%) mild anginal symptoms. It was also noteworthy that the mortality rate in the not-contacted group derived by public security records (3 out of 88, 3,4%), did not differ significantly from the contacted group.

Conclusion: Women with angina, a positive SPECT for reversible ischemia and no CAD or non-obstructive CAD in ICA have very low risk for MACE and fatal events and an excellent long-term cardiovascular prognosis for at least 5 years.