Exercise myocardial perfusion imaging in elderly patients
Steingart, Richard M; Hodnett, Patty; Musso, Joseph; Feuerman, Martin
BACKGROUND:Exercise myocardial perfusion imaging (MPI) has significant value for risk stratification, but most patients studied have been middle-aged. In particular, the value of exercise MPI in elderly patients with interpretable electrocardiographic (ECG) stress test results has not been well defined. MEHODS AND RESULTS: Clinical, ECG stress test, MPI, and follow-up data for 626 outpatients aged 65 years or older with interpretable electrocardiograms undergoing symptom-limited exercise MPI between 1992 and 1996 were analyzed. Follow-up was 97% complete after 4.4 +/- 1.3 years. After exclusion of the 27 patients who underwent revascularization within 90 days of MPI, there were 361 men and 217 women, aged 70.7 +/- 4.4 years. By univariate analysis, male sex, increasing age, an abnormal rest ECG result, lower exercise tolerance and lower peak exercise heart rates, exercise ST-segment depression, left ventricular dilatation, and the number of ischemic regions predicted death or myocardial infarction. By multivariable modeling, only increasing patient age, male sex, limitation of exercise tolerance, and the number of ischemic segments by MPI were predictive of subsequent death or myocardial infarction. CONCLUSIONS:In elderly patients referred for exercise MPI, age, sex, exercise tolerance, and MPI ischemia provide significant prognostic information.