BACKGROUND: Although the use of myocardial perfusion imaging (MPI) for prognostic purposes in general population is well understood, its role in very elderly patients is not extensively studied. METHODS: 247 octgogenarians (79% male, 56% previous myocardial infarction-MI or revascularization) who underwent treadmill exercise testing (TET) with MPI were studied. TET and MPI-related data were registered per patient and prospective follow-up was performed to document all cause death (ACD), cardiac death (CD), non-fatal MI, and late revascularization (LR). Kaplan-Meier and Cox-regression analysis were used to compute event-free survival and identify significant predictors of these events. RESULTS: After 7.3 years there were 48 deaths, 17 CDs, 8 MIs, and 21 LRs. 69 patients were classified as high and 103 as low risk by SSS with annual cardiac mortality rates of 5% and 0.9%, respectively. Differences between survival curves of SSS-based risk groups were significant for ACD, CD, CD/MI, and CD/MI/LR. Summed stress (SSS) and difference scores were the only significant predictors of all endpoints. LVEF and transient ischemic LV dilatation were significant predictors of CD and CD/MI. LVEF and all MPI variables were associated with the CD, MI, and LR endpoint while only Duke treadmill score and angina severity demonstrated such a relationship among TET variables. CONCLUSIONS: In octogenarians, MPI provides effective long-term risk stratification for both hard (ACD, CD, CD/MI) and soft (CD/MI/LR) endpoints and should be preferred over simple TET.
BACKGROUND: Although the use of myocardial perfusion imaging (MPI) for prognostic purposes in general population is well understood, its role in very elderly patients is not extensively studied. METHODS: 247 octgogenarians (79% male, 56% previous myocardial infarction-MI or revascularization) who underwent treadmill exercise testing (TET) with MPI were studied. TET and MPI-related data were registered per patient and prospective follow-up was performed to document all cause death (ACD), cardiac death (CD), non-fatal MI, and late revascularization (LR). Kaplan-Meier and Cox-regression analysis were used to compute event-free survival and identify significant predictors of these events. RESULTS: After 7.3 years there were 48 deaths, 17 CDs, 8 MIs, and 21 LRs. 69 patients were classified as high and 103 as low risk by SSS with annual cardiac mortality rates of 5% and 0.9%, respectively. Differences between survival curves of SSS-based risk groups were significant for ACD, CD, CD/MI, and CD/MI/LR. Summed stress (SSS) and difference scores were the only significant predictors of all endpoints. LVEF and transient ischemic LV dilatation were significant predictors of CD and CD/MI. LVEF and all MPI variables were associated with the CD, MI, and LR endpoint while only Duke treadmill score and angina severity demonstrated such a relationship among TET variables. CONCLUSIONS: In octogenarians, MPI provides effective long-term risk stratification for both hard (ACD, CD, CD/MI) and soft (CD/MI/LR) endpoints and should be preferred over simple TET.
Authors: Luciano Janussi Vacanti; Andrei Carvalho Sposito; Luciano Séspedes; Maíra Sarpi; José Antonio F Ramires; Anna E Bortnick Journal: Arq Bras Cardiol Date: 2007-05 Impact factor: 2.000
Authors: Kristian Thygesen; Joseph S Alpert; Allan S Jaffe; Maarten L Simoons; Bernard R Chaitman; Harvey D White; Kristian Thygesen; Joseph S Alpert; Harvey D White; Allan S Jaffe; Hugo A Katus; Fred S Apple; Bertil Lindahl; David A Morrow; Bernard R Chaitman; Peter M Clemmensen; Per Johanson; Hanoch Hod; Richard Underwood; Jeroen J Bax; Jeroen J Bonow; Fausto Pinto; Raymond J Gibbons; Keith A Fox; Dan Atar; L Kristin Newby; Marcello Galvani; Christian W Hamm; Barry F Uretsky; Ph Gabriel Steg; William Wijns; Jean-Pierre Bassand; Phillippe Menasche; Jan Ravkilde; E Magnus Ohman; Elliott M Antman; Lars C Wallentin; Paul W Armstrong; Maarten L Simoons; James L Januzzi; Markku S Nieminen; Mihai Gheorghiade; Gerasimos Filippatos; Russell V Luepker; Stephen P Fortmann; Wayne D Rosamond; Dan Levy; David Wood; Sidney C Smith; Dayi Hu; Jose-Luis Lopez-Sendon; Rose Marie Robertson; Douglas Weaver; Michal Tendera; Alfred A Bove; Alexander N Parkhomenko; Elena J Vasilieva; Shanti Mendis; Jeroen J Bax; Helmut Baumgartner; Claudio Ceconi; Veronica Dean; Christi Deaton; Robert Fagard; Christian Funck-Brentano; David Hasdai; Arno Hoes; Paulus Kirchhof; Juhani Knuuti; Philippe Kolh; Theresa McDonagh; Cyril Moulin; Bogdan A Popescu; Zeljko Reiner; Udo Sechtem; Per Anton Sirnes; Michal Tendera; Adam Torbicki; Alec Vahanian; Stephan Windecker; Joao Morais; Carlos Aguiar; Wael Almahmeed; David O Arnar; Fabio Barili; Kenneth D Bloch; Ann F Bolger; Hans Erik Botker; Biykem Bozkurt; Raffaele Bugiardini; Christopher Cannon; James de Lemos; Franz R Eberli; Edgardo Escobar; Mark Hlatky; Stefan James; Karl B Kern; David J Moliterno; Christian Mueller; Aleksandar N Neskovic; Burkert Mathias Pieske; Steven P Schulman; Robert F Storey; Kathryn A Taubert; Pascal Vranckx; Daniel R Wagner Journal: J Am Coll Cardiol Date: 2012-09-05 Impact factor: 24.094
Authors: D B Mark; L Shaw; F E Harrell; M A Hlatky; K L Lee; J R Bengtson; C B McCants; R M Califf; D B Pryor Journal: N Engl J Med Date: 1991-09-19 Impact factor: 91.245