Francesco Nudi1,2,3, Giuseppe Biondi-Zoccai4,5, Orazio Schillaci6, Natale di Belardino7, Francesco Versaci8, Alessandro Nudi9, Annamaria Pinto10,11, Giandomenico Neri10, Enrica Procaccini10, Giacomo Frati4,5, Ami E Iskandrian12. 1. Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Rome, Italy. francesco.nudi@gmail.com. 2. ETISAN, Rome, Italy. francesco.nudi@gmail.com. 3. Service of Hybrid Cardio Imaging, Madonna della Fiducia Clinic, Via Giuseppe Mantellini 3, 00179, Rome, Italy. francesco.nudi@gmail.com. 4. Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy. 5. Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy. 6. Department of Nuclear Medicine, Tor Vergata University, Rome, Italy. 7. Division of Cardiology, Anzio-Nettuno Hospital, Anzio, Italy. 8. Division of Cardiology, S. Maria Goretti Hospital, Latina, Italy. 9. ETISAN, Rome, Italy. 10. Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Rome, Italy. 11. Ostia Radiologica, Rome, Italy. 12. Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA.
Abstract
BACKGROUND: Myocardial perfusion imaging (MPI) has an established role in the work-up of coronary artery disease (CAD), but its comparative accuracy is debated in elderly patients. We examined a large administrative database to appraise the performance of MPI in octogenarians. METHODS: Our institutional database was queried for patients undergoing MPI without recent coronary revascularization or myocardial infarction (MI). We compared baseline, procedural, diagnostic, and prognostic features in patients aged < 80 vs ≥ 80 years with bivariate and propensity-adjusted analyses. RESULTS: From 13,254 patients, 12,737 (96.1%) were < 80 years old and 517 (3.9%) ≥ 80 years. Octogenarians were less likely to undergo exercise testing, had more severe and extensive myocardial ischemia (all P < 0.001), whereas CAD was more prevalent and diffuse in them (P = 0.012), and major adverse cardiac events more common during follow-up (P = 0.009). Diagnostic accuracy of MPI was similar or higher in octogenarians than in younger patients (e.g., sensitivity for three-vessel disease 92% in octogenarians vs 91% in younger patients), as was prognostic accuracy. Using propensity-matched analyses, MPI again yielded satisfactory prognostic accuracy in octogenarians. CONCLUSIONS: Use of MPI in octogenarians is associated with similar or better prognostic accuracy than in younger subjects.
BACKGROUND: Myocardial perfusion imaging (MPI) has an established role in the work-up of coronary artery disease (CAD), but its comparative accuracy is debated in elderly patients. We examined a large administrative database to appraise the performance of MPI in octogenarians. METHODS: Our institutional database was queried for patients undergoing MPI without recent coronary revascularization or myocardial infarction (MI). We compared baseline, procedural, diagnostic, and prognostic features in patients aged < 80 vs ≥ 80 years with bivariate and propensity-adjusted analyses. RESULTS: From 13,254 patients, 12,737 (96.1%) were < 80 years old and 517 (3.9%) ≥ 80 years. Octogenarians were less likely to undergo exercise testing, had more severe and extensive myocardial ischemia (all P < 0.001), whereas CAD was more prevalent and diffuse in them (P = 0.012), and major adverse cardiac events more common during follow-up (P = 0.009). Diagnostic accuracy of MPI was similar or higher in octogenarians than in younger patients (e.g., sensitivity for three-vessel disease 92% in octogenarians vs 91% in younger patients), as was prognostic accuracy. Using propensity-matched analyses, MPI again yielded satisfactory prognostic accuracy in octogenarians. CONCLUSIONS: Use of MPI in octogenarians is associated with similar or better prognostic accuracy than in younger subjects.
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