Sex-based differences in myocardial perfusion imaging among diabetic Egyptian patients:a retrospective registry study.

Background

Diabetes mellitus (DM) markedly increases the risk of coronary artery disease (CAD), and myocardial perfusion imaging (MPI) is a key noninvasive tool for risk stratification. Sex-based differences in presentation, referral patterns, and diagnostic accuracy of MPI remain understudied, particularly in Middle Eastern populations with a high prevalence of diabetes. This study evaluated sex-based differences in the indications, results, appropriateness, and diagnostic accuracy of MPI among diabetic Egyptian patients.

Methods

This retrospective observational registry study included 1,000 diabetic adults (648 men, 352 women) who underwent gated SPECT-MPI at our university hospitals. Demographic data, risk factors, ECG findings, stress modalities, MPI results, coronary angiography data, and appropriate use criteria (AUC) were analyzed.

Results

Men were older than women (59.6 ± 8.0 vs. 57.0 ± 9.4 years, p < 0.001). Hypertension was more prevalent in women (84.1% vs. 67.6%, p < 0.001), whereas smoking was more common in men (30.4% vs. 0.3%, p < 0.001). Positive MPI results were more frequent in men (77.0% vs. 43.2%, p < 0.001), as were appropriate indications (79.3% vs. 53.4%, p < 0.001); inappropriate and uncertain indications were correspondingly more common in women. Reversible perfusion defects did not differ significantly by sex (23.6% in women vs. 21.2% in men, p = 0.523), whereas fixed defects were more prevalent in men (17.0% vs. 7.8%, p < 0.001). MPI accuracy relative to coronary angiography did not differ significantly between the sexes (91.7% in men vs. 86.3% in women, p = 0.103).

Conclusion

Substantial sex-based disparities exist in MPI referral patterns, test positivity, and appropriateness among diabetic Egyptians. Women are more likely to receive inappropriate referrals and to have a lower positive diagnostic yield, underscoring the need for sex-sensitive clinical protocols.