Prognostic Implications of Myocardial Perfusion Single-Photon Emission Computed Tomography in the Elderly

被引:88
作者
Hachamovitch, Rory [1 ,2 ]
Kang, Xingping [1 ,2 ]
Amanullah, Aman M. [3 ]
Abidov, Aiden [1 ,2 ,4 ]
Hayes, Sean W. [1 ,2 ]
Friedman, John D. [1 ,2 ]
Cohen, Ishac [1 ,2 ]
Thomson, Louise E. J. [1 ,2 ]
Germano, Guido [1 ,2 ]
Berman, Daniel S. [1 ,2 ]
机构
[1] Cedars Sinai Med Ctr, Dept Imaging, Div Nucl Med, Div Cardiol,Dept Med, Los Angeles, CA 90048 USA
[2] Cedars Sinai Med Ctr, CSMC Burns & Allen Res Inst, Los Angeles, CA 90048 USA
[3] Albert Einstein Med Ctr, Dept Med, Div Cardiovasc Dis, Philadelphia, PA 19141 USA
[4] Univ Arizona, Coll Med, Saver Heart Ctr, Tucson, AZ USA
关键词
elderly; prognosis; survival; tomography; emission-computed; single-photon; ventricular function; left; VENTRICULAR EJECTION FRACTION; CORONARY-ARTERY-DISEASE; RISK STRATIFICATION; GATED SPECT; VALIDATION; BENEFIT;
D O I
10.1161/CIRCULATIONAHA.108.817387
中图分类号
R5 [内科学];
学科分类号
100201 [内科学];
摘要
Background-The goal of this study was to assess the clinical value of stress myocardial perfusion scintigraphy (MPS) in elderly patients (>= 75 years of age). Methods and Results-We followed up 5200 elderly patients (41% exercise) after dual-isotope MPS over 2.8 +/- 1.7 years (362 cardiac deaths [CDs], 7.0%, 2.6%/y) and a subset with extended follow-up (684 patients for 6.2 +/- 2.9 years; 320 all-cause deaths). Survival modeling of CD revealed that both MPS-measured ischemia and fixed defect added incrementally to pre-MPS data in both adenosine and exercise stress patients. Modeling a subset with gated MPS (n = 2472) revealed that ejection fraction and perfusion data added incrementally to each other, further enhancing risk stratification. Unadjusted, annualized post-normal MPS CD rate was 1.3% but <1% in patients with normal rest ECG, exercise stress, or age of 75 to 84 years and was 2.3% to 3.7% in patients >= 85 years of age or undergoing pharmacological stress. However, compared with age-matched US population CD rates (75 to 84 years of age, 1.5%; >= 85 years, 4.8%), normal MPS CD rates were approximately one-third lower than the baseline risk of US individuals (both P < 0.05). Modeling of all-cause death in 684 patients with extended follow-up revealed that after risk adjustment, an interaction between early treatment and ischemia was present; increasing ischemia was associated with increasing survival with early revascularization, whereas in the setting of little or no ischemia, medical therapy had improved outcomes. Conclusions-Stress MPS effectively stratifies CD risk in elderly patients and may identify optimal post-MPS therapy. CD rates after normal MPS are low in all subsets in relative terms compared with the age-matched US population. (Circulation. 2009; 120: 2197-2206.)
引用
收藏
页码:2197 / 2206
页数:10
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