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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 . 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 .
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Intervention_Physical
ECG
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Intervention_Physical
ETT
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Outcome_Other
Comparative effectiveness
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Participant_Condition
women with suspected coronary artery disease :
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Participant_Condition
women with suspected coronary artery disease ( CAD ) .