Gender Differences in the Diagnostic Accuracy of SPECT Myocardial Perfusion Imaging: A

Gender Differences in the Diagnostic Accuracy of SPECT Myocardial Perfusion Imaging: A Bivariate Meta-analysis

Aline Iskandar, MD, Brendan Limone, PharmD, Matthew W. Parker, MD, Andrew Perugini, PharmD, Hyejin Kim, PharmD, Charles Jones, PharmD, Brian

Calamari PharmD, Craig I. Coleman, PharmD, Gary V. Heller, MD, PhD

Supplemental Materials

SUPPLEMENTAL METHODS

QUADAS Items and Guidelines for Scoring

1. Was the spectrum of patients representative of the patients who will receive in the test in practice? (Patient spectrum).

To be scored “yes”, the prevalence of coronary artery disease could not be higher than 70%.

1. Were selection criteria clearly described? (Selection criteria)

To be scored “yes”, the article had to at least report inclusion and exclusion criteria.

1. Is the reference standard likely to correctly classify the target condition? (Reference standard)

To be scored “yes”, investigators had to perform quantitative coronary angiography using a threshold of 50% stenosis.

1. Is the period between reference standard and index test short enough to be reasonably sure that the target condition did not change between the two tests? (Disease progression bias)

To be scored “yes”, stress myocardial perfusion imaging and coronary angiography had to be performed within 30 days.

1. Did the whole sample or a random selection of the sample receive verification using the reference standard? (Partial verification bias)

To be scored “yes”, subjects had to undergo coronary angiography regardless of stress myocardial perfusion images findings.

1. Did patients receive the same reference standard regardless of the index test result? ( Differential verification)

All studies were scores “yes” based on the inclusion criteria.

1. Was the reference standard independent of the index test (i.e., the index test did not form part of the reference standard)? (Incorporation bias)

All studies were scores “yes” based on the inclusion criteria.

1. Was the execution of the index test described in sufficient detail to permit replications of the test? ( Test details)

To be scored “yes”, the study had to specify type of stress used, radiotracer used, and data acquisition and reconstruction settings.

1. Was the execution of the reference standard described in sufficient detail to permit its replication? (Reference standard details)

To be scored “yes”, the study had to state whether conventional coronary angiography or quantitative angiography was performed, and if conventional angiography, state method for evaluating stenosis (i.e., “worst view” or “average of multiple views”) or if quantitative angiography, describe or cite the quantitative technique used.

1. Were the index test results interpreted without knowledge of the result of the reference standard? (Test review bias)

To be scored “yes”, the investigators had to clearly state that stress myocardial perfusion images were interpreted without knowledge of the results of the coronary angiograms.

1. Were the reference standard results interpreted without knowledge of the results of the reference standard? (Diagnostic review bias)

To be scored “yes”, the investigators had to clearly state that coronary angiograms were interpreted without results of the stress myocardial perfusion imaging.

1. Were the same clinical data available when test results were interpreted as would be available when the test is used in practice? (Clinical data)

To be scored “yes”, the investigators had to provide clinical data when stress myocardial perfusion images were being interpreted.

1. Were uninterpretable or intermediate test results reported? (Uninterpretable results)

To be scored “yes”, study investigators had to report any uninterpretable results or state that there were no uninterpretable results.

1. Were withdrawals from the study explained? (Withdrawals)

To be scored “yes”, the study investigators had to clearly show the disposition of all patients who entered the study, preferably by reporting a flow diagram of all study participants or at least by reporting the number and disposition of withdrawals.

Abbreviations: n=number of patients; NR=not reported; y=year(s); SD = standard deviation.

Abbreviations: GE = General Electric; NR = Not Reported; SPECT = Single Photon Emission Computed Tomography.

Abbreviations: CAD = Coronary Artery Disease; mCi = millicurie; MI = Myocardial Infarction; NR = Not Reported; Tc99m = Technetium-99m.

*Age range 30-45 years. Abbreviations: n=number of patients; NR=not reported; SD = standard deviation; y=year(s).

Abbreviations: AC = Attenuation Correction GE = General Electric; NR = Not Reported; SPECT = Single Photon Emission Computed Tomography.

Abbreviations: CAD = Coronary Artery Disease; mCi = millicurie; MI = Myocardial Infarction; NR = Not Reported; Tc99m = Technetium-99m.

“Yes” scores indicate that a study clearly reported measures taken to reduce the indicated source of bias. See QUADAS Tool in Appendix 1.

“Yes” scores indicate that a study clearly reported measures taken to reduce the indicated source of bias. See QUADAS Tool in Appendix 1.

“Yes” scores indicate that a study clearly reported measures taken to reduce the indicated source of bias. See QUADAS Tool in Appendix 1.

“Yes” scores indicate that a study clearly reported measures taken to reduce the indicated source of bias. See QUADAS Tool in Appendix 1.