Adenosine triphosphate stress myocardial perfusion imaging for risk stratification of patients aged 70 years and older with suspected coronary artery disease
ObjectiveWe 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).MethodsWe 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.ResultsOne 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.ConclusionsATP MPI data are useful for the prediction of major adverse cardiac events in patients aged 70 years and older with suspected CAD.
Journal of Nuclear Cardiology