The clinical value of single photon emission computed tomography myocardial perfusion imaging in cardiac risk stratification of very elderly patients (≥80 years) with suspected coronary artery disease
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The role of single photon emission computed tomography myocardial perfusion imaging (SPECT MPI) in cardiac evaluation of the very elderly patients is unclear. We investigated the clinical value of SPECT MPI in very elderly patients (≥80 years) with suspected coronary artery disease (CAD) as well as in comparison to younger patients.
Methods and Results
A retrospective analysis of prospectively collected data from 8,864 patients [1,093 patients ≥80 years (very elderly), 3,369 patients 65-79 years (elderly), and 4,402 patients 50-64 years (middle-aged)] with suspected CAD who underwent exercise and/or pharmacologic stress testing with SPECT MPI between 1996 and 2005 was performed. Clinical and SPECT MPI characteristics, cardiac event rates, early (≤60 days) cardiac catheterization and revascularization rates of very elderly patients were compared to that of younger patients. Mean follow-up for cardiac events (cardiac death or non-fatal myocardial infarction) was 1.9 ± 0.9 years. Very elderly patients with moderate to severely abnormal SSS had a significantly higher annualized cardiac event rate than those with mildly abnormal or normal study (9.6% vs 3.4% and 2.5% respectively, P < .001). Across all categories of SSS, very elderly patients had a significantly higher cardiac event rate as compared to younger patients (P < .001). Early cardiac catheterization and revascularization referrals in very elderly patients increased as a function of severity of ischemia on SPECT MPI (P < .001), although these referral rates were significantly lower in very elderly patients with mild to moderate and severe ischemia as compared to younger patients (P < .05).
In very elderly patients (≥80 years) with suspected CAD, SPECT MPI has prognostic and incremental value in the noninvasive cardiovascular assessment for risk stratification and may influence medical decisions.
KeywordsElderly prognosis single-photon emission-computed tomography myocardial perfusion imaging revascularization
We thank David O’Sullivan, PhD for his help in reviewing an earlier version of this manuscript.
- 1.American Heart Association. Heart Disease and Stroke Statistics-2009 Update. Dallas, TX: American Heart Association; 2009.www.americanheart.org. Accessed January 2010.
- 5.Aronow WS. Silent MI. Prevalence and prognosis in older patients diagnosed by routine electrocardiograms. Geriatrics 2003;58:24-8, 40Google Scholar
- 15.Gibbons RJ, Balady GJ, Bricker JT, Chaitman BR, Fletcher GF, Froelicher VF, et al. ACC/AHA 2002 guideline update for exercise testing: Summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). J Am Coll Cardiol 2002;40:1531-40.PubMedCrossRefGoogle Scholar
- 16.Klocke FJ, Baird MG, Lorell BH, Bateman TM, Messer JV, Berman DS, et al. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging-executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging). Circulation 2003;108:1404-18.PubMedCrossRefGoogle Scholar
- 20.Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 2002;105:539-42.PubMedCrossRefGoogle Scholar
- 21.Hachamovitch R, Berman DS, Shaw LJ, Kiat H, Cohen I, Cabico JA, et al. Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death: Differential stratification for risk of cardiac death and myocardial infarction. Circulation 1998;97:535-43.PubMedCrossRefGoogle Scholar
- 22.Sharir T, Germano G, Kang X, Lewin HC, Miranda R, Cohen I, et al. Prediction of myocardial infarction versus cardiac death by gated myocardial perfusion SPECT: Risk stratification by the amount of stress-induced ischemia and the poststress ejection fraction. J Nucl Med 2001;42:831-7.PubMedGoogle Scholar
- 23.McClellan JR, Travin MI, Herman SD, Baron JI, Golub RJ, Gallagher JJ, et al. Prognostic importance of scintigraphic left ventricular cavity dilation during intravenous dipyridamole technetium-99m sestamibi myocardial tomographic imaging in predicting coronary events. Am J Cardiol 1997;79:600-5.PubMedCrossRefGoogle Scholar
- 32.Amanullah AM, Kiat H, Hachamovitch R, Cabico JA, Cohen I, Friedman JD, et al. Impact of myocardial perfusion single-photon emission computed tomography on referral to catheterization of the very elderly. Is there evidence of gender-related referral bias? J Am Coll Cardiol 1996;28:680-6.PubMedCrossRefGoogle Scholar
- 38.Hueb WA, Soares PR, Meida De OS, Arie S, Cardoso RH, Wajsbrot DB, et al. Five-year follow-op of the medicine, angioplasty, or surgery study (MASS): A prospective, randomized trial of medical therapy, balloon angioplasty, or bypass surgery for single proximal left anterior descending coronary artery stenosis. Circulation 1999;100:107-13.CrossRefGoogle Scholar