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.
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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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