Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Rome, Italy.
ETISAN, Rome, Italy.
J Nucl Cardiol. 2018 Aug;25(4):1342-1349. doi: 10.1007/s12350-017-1102-x. Epub 2017 Nov 1.
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.
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.
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.
Use of MPI in octogenarians is associated with similar or better prognostic accuracy than in younger subjects.
心肌灌注成像（MPI）在冠状动脉疾病（CAD）的检查中具有明确的作用，但在老年患者中的准确性仍存在争议。我们研究了一个大型的行政数据库，以评估 MPI 在 80 岁以上患者中的应用价值。
我们对未接受近期冠状动脉血运重建或心肌梗死（MI）的患者进行了 MPI 检查，检索了我们机构的数据库。我们比较了年龄<80 岁和年龄≥80 岁的患者的基线、操作、诊断和预后特征，并进行了双变量和倾向调整分析。
从 13254 例患者中，12737 例（96.1%）年龄<80 岁，517 例（3.9%）年龄≥80 岁。80 岁以上的患者进行运动试验的可能性较小，其心肌缺血更严重、范围更广（均 P<0.001），而 CAD 在他们中更常见且更弥漫（P=0.012），且在随访期间更常见重大心脏不良事件（P=0.009）。MPI 的诊断准确性在 80 岁以上的患者中与年轻患者相似或更高（例如，三支血管病变的敏感性在 80 岁以上的患者中为 92%，在年轻患者中为 91%），预后准确性也相似。使用倾向匹配分析，MPI 再次在 80 岁以上的患者中显示出令人满意的预后准确性。
MPI 在 80 岁以上患者中的应用与年轻患者相似或具有更好的预后准确性。
