Noninvasive test of choice to detect coronary artery disease in the elderly

Background and purpose. The purpose of this study was to determine the best noninvasive test to diagnose coronary artery disease in the elderly. Patients and methods. We conducted a study on 56 elderly patients (> 65 years) with chest pain and no previous history of coronary artery disease. They underwent exercise stress test, dipyridamole echocardiography (0.84 mg/kg), dobutamine echocardiography (up to a total dose of 40 mu g/kg/min and atropine when it was necessary), dobutamine-MIBI-SPECT and coronary angiography. Results. Angiography detected significant coronary artery disease in 41 patients. All tests used in this study had a similar sensitivity (conclusive exercise stress test 87%, dipyridamole echocardiography 83%, dobutamine echocardiography 80% and MIBI-SPECT 87%; p = NS). Coronary angiography did not identify significant lesions in 15 patients. Specificity of conclusive exercise stress test, dipyridamole and dobutamine echocardiography was similar (75%, 100% and 93% respectively; p = NS). However, the specificity of stress echocardiography was higher than that of scintigraphy (100% vs 66%; p = 0.02 for dipyridamole echocardiography and 93% vs 66%; p = 0.07 for dobutamine echocardiography). Diagnostic accuracy of each test was similar. Conclusions. Exercise stress test remains the non invasive diagnostic test of choice to detect coronary disease in the elderly. If this test is inconclusive, both stress echocardiography and isotopic studies are useful, although the specificity of stress echocardiography is higher than that of scintigraphy.