Abstract
Background: Octogenarian patients referred for stress myocardial perfusion imaging (MPI) differ from younger (non‐octogenarian) patients in that they have lower prevalence of risk factors for CAD, but more frequent ischemic events and higher cardiac mortality.
Hypothesis: The purpose of this study was to investigate the efficacy of MPI in octogenarian men and women compared with that in the younger population, and to compare the prognostic value of stress MPI in both populations.
Methods: We studied 162 consecutive patients aged ≥ 80 years who were referred for stress MPI, and compared them with 253 consecutive patients aged < 80 years. Patients completed a questionnaire encompassing information about the existence of coronary risk factors, cardiac symptoms, coronary artery disease (CAD), myocardial infarction, coronary artery bypass graft, percutaneous transluminal coronary angioplasty, and results of stress MPI. The patients were followed up for cardiac mortality for a mean of 45 ± 12 months.
Results: There were 61 women and 101 men (17% of all referrals) with a mean age of 83 ± 3 (range 80‐90). Parameters of octogenarian patients demonstrated a significantly lower prevalence of non‐insulin‐dependent diabetes mellitus (p < 0.02), hypercholestrolemia (p < 0.001), and smoking (p = 0.001) compared with non‐octogenarian patients. The prevalence of known CAD was similar, but the prevalence of abnormal resting electrocardiogram, left ventricular (LV) dilatation, and stress‐induced ischemia was significantly higher in octogenarians (p < 0.002). Cardiac mortality rate peryear was 4.3%in octogenarians versus 1.3%in the younger population (p < 0.0001). The independent predictors according to MPI of cardiac death were LV dilatation and presence of ischemia in octogenarians, and severity of ischemia in non‐octogenarians.
Conclusions: The octogenarian population referred for stress single‐photon emission computed tomography differed from the non‐octogenarian group in that it had a lower prevalence of risk factors for CAD, but more frequent ischemic events and higher cardiac mortality; however, MPI variables predict adverse outcome in both populations.
Keywords: octogenarians, non‐octogenarians, coronary artery disease, myocardial perfusion imaging, myocardial ischemia, cardiac mortality
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References
- 1. Foot DK, Lewis RP, Pearson TA, Beller GA: Demographics and cardiology, 1950–2050. J Am Coll Cardiol 2000; 35: 66B–80B [PubMed] [Google Scholar]
- 2. Gibbons RJ: And what do we tell our elders. J Nucl Cardiol 2002; 9: 672–674 [DOI] [PubMed] [Google Scholar]
- 3. Kwok JMF, Miller TD, Hodge DO, Gibbons RJ: Prognostic value of Duke treadmill score in the elderly. J Am Coll Cardiol 2002; 39: 1475–1481 [DOI] [PubMed] [Google Scholar]
- 4. Hachamovitch R, Berman DS, Kiat H, Cohen I, Cabico JA, Friedman J, Diamond GA: Exercise myocardial perfusion SPECT in patients without known coronary artery disease. Incremental prognostic value and use in risk stratification. Circulation 1996; 93: 905–914 [DOI] [PubMed] [Google Scholar]
- 5. Goraya TY, Jacobsen SJ, Pellikka PA, Miller TD, Khan A, Weston SA, Gersh BJ, Roger VL: Prognostic value of treadmill exercise testing in elderly persons. Ann Intern Med 2000; 132: 862–870 [DOI] [PubMed] [Google Scholar]
- 6. Spin JM, Prakash M, Froelicher VF, Partington S, Marcus R, Do D, Myers J: The prognostic value of exercise testing in elderly men. Am J Med 2002; 112: 453–459 [DOI] [PubMed] [Google Scholar]
- 7. Arruda AM, Das MK, Roger VL, Klarich KW, Mahoney DW, Pellikka PA: Prognostic value of exercise echocardiography in 2,632 patients ≥ 65 years of age. J Am Coll Cardiol 2001; 37: 1036–1041 [DOI] [PubMed] [Google Scholar]
- 8. Elhendy A, van Domburg RT, Bax JJ, Valkema R, Reijs AF, Krenning EP, Roelandt JR: Safety, hemodynamic profile, and feasibility of dobutamine stress technetium myocardial perfusion single‐proton emission CT imaging for evaluation of coronary artery disease in the elderly. Chest 2000; 117: 649–656 [DOI] [PubMed] [Google Scholar]
- 9. Iskandrian AS, Chae SC Heo J, Stanberry CD, Wasserleben V, Cave V: Independent and incremental prognostic value of exercise single photon emission computed tomographic (SPECT) thallium imaging in coronary artery disease. J Am Coll Cardiol 1993; 22: 665–670 [DOI] [PubMed] [Google Scholar]
- 10. The TIME investigators : Trial of invasive versus medical therapy in elderly patients with chronic symptomatic coronary artery disease (TIME): Arandomized trial. Lancet 2001; 358: 951–957 [DOI] [PubMed] [Google Scholar]
- 11. Amanullah AM, Kiat H, Hachamovitch R, Cabico JA, Cohen I, Friedman JD, Berman DS: Impact of myocardial perfusion single‐photon emission computed tomography on referral to catheterization of the very elderly. J Am Coll Cardiol 1996; 28: 680–686 [DOI] [PubMed] [Google Scholar]
- 12. Steingart RM, Hodnett P, Musso J, Feuerman M: Exercise myocardial perfusion imaging in elderly patients. J Nucl Cardiol 2002; 9: 573–580 [DOI] [PubMed] [Google Scholar]
- 13. Hilton TC, Shaw LJ, Chaitman BR, Stocke KS, Goodgold HM, Miller DD: Prognostic significance of exercise thallium‐201 testing in patients aged greater than or equal to 70 with known or suspected coronary artery disease. Am J Cardiol 1992; 69: 45–50 [DOI] [PubMed] [Google Scholar]
- 14. Hayes SW, Schisterman EF, Lewin HC: Incremental prognostic value of gated myocardial perfusion SPECT in elderly patients (abstr). J Am Coll Cardiol 2001; 37: 425a 11216957 [Google Scholar]
- 15. Zafrir N, Mats I, Solodky A, Ben‐Gal T, Sulkes J, Battler A. Prognostic value of stress myocardial perfusion imaging in octogenarian population. J Nucl Cardiol 2005; 12: 671–675 [DOI] [PubMed] [Google Scholar]
- 16. De Pasquale E, Nody R, Depuez G, Gracia E: Quantitative rotational thallium 201 tomography for identifying and localizing coronary artery disease. Circulation 1988; 77: 316–326 [DOI] [PubMed] [Google Scholar]
- 17. Gracia EV, van Train K, Maddahi J: Quantitation of rotational thallium 201 myocardial tomography. J Nucl Med 1985; 26: 17–21 [PubMed] [Google Scholar]
- 18. Valeti US, Miller TD, Hodge DO, Gibbons RJ: Exercise single‐photon emission computed tomography provides effective risk stratification of elderly men and elderly women. Circulation 2005; 111: 1771–1776 [DOI] [PubMed] [Google Scholar]
- 19. Navare SM, Mather JF, Shaw LJ, Fowler MS, Heller GV: Comparison of risk stratification with pharmacologic and exercise stress myocardial perfusion imaging: A meta‐analysis. J Nucl Cardiol 2004; 11: 551–561 [DOI] [PubMed] [Google Scholar]