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Adenosine triphosphate stress myocardial perfusion imaging for risk stratification of patients aged 70 years and older with suspected coronary artery disease

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Journal of Nuclear Cardiology Aims and scope

Abstract

Objective

We investigated the cardiac risk stratification value of adenosine triphosphate stress myocardial perfusion imaging (ATP-MPI) in patients aged 70 years and older with suspected coronary artery disease (CAD).

Methods

We identified a series of 415 consecutive patients aged 70 years and older with suspected CAD, who had undergone ATP-MPI with 99mTc-MIBI. The presence of a fixed and/or reversible perfusion defect was considered as an abnormal MPI. Follow-up was available in 399 patients (96.1%) over 3.45 ± 1.71 years after excluding 16 patients who underwent early coronary revascularization <60 days after MPI. The major adverse cardiac events (MACE), including cardiac death, nonfatal infarction, and late coronary revascularization, were recorded.

Results

One hundred twenty-five (31.3%) patients had abnormal MPI and the remaining had normal MPI. A multivariable analysis using Cox regression demonstrated that abnormal MPI was independently associated with MACE (hazard ratio 19.50 and 95% confidence interval 5.91-64.31, P value .000). The patients with SSS > 8 had significantly higher cumulative MACE rate than patients with SSS ≤ 8 had (37.8% vs 5.2%, respectively, P < .001). The Kaplan-Meier cumulative MACE-free survival in patients with abnormal MPI (57.0%) was significantly lower than that in patients with normal MPI (89.6%), P < .0001. Among patients with SSS > 8, the Kaplan-Meier cumulative MACE-free survival were 36.9% in patients ≥80 years old and 49.5% in patients 70-79 years old, respectively, P < .05. However, among patients with SSS ≤ 8, there was no difference between the Kaplan-Meier cumulative MACE-free survivals of these two age groups.

Conclusions

ATP-MPI data are useful for the prediction of major adverse cardiac events in patients aged 70 years and older with suspected CAD.

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Figure 1

Abbreviations

ATP:

Adenosine triphosphate

MPI:

Myocardial perfusion imaging

ATP-MPI:

ATP stress myocardial perfusion imaging

CAD:

Coronary artery disease

SSS:

Summed stress score

SDS:

Summed difference score

ECG:

Electrocardiograph

MACE:

Major adverse cardiac events

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Disclosure

There are no conflicts of interest.

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Correspondence to Zhiming Yao MD, PhD.

Additional information

See related editorial, doi:10.1007/s12350-016-0408-4.

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Yao, Z., Zhu, H., Li, W. et al. Adenosine triphosphate stress myocardial perfusion imaging for risk stratification of patients aged 70 years and older with suspected coronary artery disease. J. Nucl. Cardiol. 24, 429–433 (2017). https://doi.org/10.1007/s12350-015-0355-5

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  • DOI: https://doi.org/10.1007/s12350-015-0355-5

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