STUDY OBJECTIVES: To define the prognostic value of stress testing (STRT) in patients >or= 75 years of age. DESIGN: Multicenter prospective randomized trial. SETTING: Tertiary care centers. PATIENTS: Two hundred ninety-two patients of the Trial of Invasive vs Medical Treatment of Elderly Patients aged >or= 75 years with chronic angina despite receiving two or more antianginal drugs were prospectively observed for 1 year. INTERVENTION: STRT (88% exercise ECG; 12% pharmacologic stress imaging) was performed if possible, and ischemia was diagnosed using current guidelines. Death for any reason and nonfatal myocardial infarction were outcome events. RESULTS:Patients who could perform STRT (148 patients) were younger, had a lower risk profile, received less medication, and had less severe angina than patients who could not perform STRT (144 patients). The 1-year mortality rate was only 1.4% in patients with negative STRT results (72 patients) compared to 5.3% in patients with positive STRT results (76 patients) and 13.7% in patients who had not undergone STRT due to unstable symptoms (95 patients). The corresponding 1-year rates of death/infarction were 2.8%, 15.8%, and 26.3%, respectively. After adjustment for baseline differences, mortality rates were no longer significantly different. However, compared to patients with negative STRT results, infarction and death/infarction rates remained higher in patients with provocable ischemia (hazard ratio [HR], 8.9 [p = 0.04]; HR, 6.1 [p = 0.02], respectively) and in patients without STRT due to unstable angina (HR, 11.8 [p = 0.02]; HR, 8.6 [p =.004], respectively). CONCLUSIONS: STRT in elderly patients is feasible and provides important prognostic information for their future management. Patients with negative STRT results after receiving therapy have a good prognosis, and their conditions may be managed conservatively.
RCT Entities:
STUDY OBJECTIVES: To define the prognostic value of stress testing (STRT) in patients >or= 75 years of age. DESIGN: Multicenter prospective randomized trial. SETTING: Tertiary care centers. PATIENTS: Two hundred ninety-two patients of the Trial of Invasive vs Medical Treatment of Elderly Patients aged >or= 75 years with chronic angina despite receiving two or more antianginal drugs were prospectively observed for 1 year. INTERVENTION: STRT (88% exercise ECG; 12% pharmacologic stress imaging) was performed if possible, and ischemia was diagnosed using current guidelines. Death for any reason and nonfatal myocardial infarction were outcome events. RESULTS:Patients who could perform STRT (148 patients) were younger, had a lower risk profile, received less medication, and had less severe angina than patients who could not perform STRT (144 patients). The 1-year mortality rate was only 1.4% in patients with negative STRT results (72 patients) compared to 5.3% in patients with positive STRT results (76 patients) and 13.7% in patients who had not undergone STRT due to unstable symptoms (95 patients). The corresponding 1-year rates of death/infarction were 2.8%, 15.8%, and 26.3%, respectively. After adjustment for baseline differences, mortality rates were no longer significantly different. However, compared to patients with negative STRT results, infarction and death/infarction rates remained higher in patients with provocable ischemia (hazard ratio [HR], 8.9 [p = 0.04]; HR, 6.1 [p = 0.02], respectively) and in patients without STRT due to unstable angina (HR, 11.8 [p = 0.02]; HR, 8.6 [p =.004], respectively). CONCLUSIONS: STRT in elderly patients is feasible and provides important prognostic information for their future management. Patients with negative STRT results after receiving therapy have a good prognosis, and their conditions may be managed conservatively.
Authors: Bradley S Lander; Aimee M Layton; Robert P Garofano; Allan Schwartz; David J Engel; Natalie A Bello Journal: Am J Cardiol Date: 2021-11-26 Impact factor: 2.778
Authors: Sundeep Mishra; Saumitra Ray; Jamshed J Dalal; J P S Sawhney; S Ramakrishnan; Tiny Nair; S S Iyengar; V K Bahl Journal: Indian Heart J Date: 2016-12-09