Coronary disease & ACSResearch article
Use of Myocardial Perfusion Imaging to Guide Prognosis and Management in Older Adults: Is There an Age Limit?
- Propensity score-adjusted Cox models
- 20 sites
- 2009 to 2024
Authors' conclusion
Ischemia remains prognostic across all ages and may help identify candidates who have improved outcomes with ER. In an exploratory analysis, this association appeared attenuated in patients aged ≥85 years, a hypothesis-generating observation. Positron emission tomography-derived myocardial flow reserve may provide complementary physiological information for treatment selection in older adults.
Study context
- Population
- Patients who underwent single photon emission computed tomography or positron emission tomography myocardial perfusion imagingpatients who underwent myocardial perfusion imaging · single photon emission computed tomography 45,252 · positron emission tomography 27,786
- Participants
- 73,038 patients
- Comparison
- Early revascularization (ER) versus medical therapy, by age group and ischemic burden
- Outcome
- All-cause death or nonfatal myocardial infarction
- Follow-up
- Median 3.7 years
Main finding
As reported in the abstract
Deaths/myocardial infarctions
10 757
Continuous age-ischemia-ER interaction, not significant
P =0.748
Further findings
Age distribution
- Median age
- 66 years
- <65
- 45.3%
- 65 to 74
- 31.5%
- 75 to 84
- 19.1%
- ≥85
- 4.2%
ER performed
- Overall
- 6.1%
- Aged 75 to 84 years
- 7.0%
- Aged ≥85 years
- 6.5%
Ischemia >10% and ER association, patients aged ≥85 years (exploratory)
- Patients aged ≥85 years
- 3031
- hazard ratio for ischemia >10%
- 0.90 [0.64-1.26]
- Patients undergoing ER
- n=198
- exploratory analysis
- association appeared attenuated
- precision was limited
Myocardial flow reserve×ER association by age (positron emission tomography patients)
- Did not vary with age (3-way interaction)
- P = 0.689
Prognostic value of ischemia, excluding patients with ER
- Ischemia remained prognostic in all age groups, though its associated risk declined with advancing age
Original publication
Summarised from the published abstract; every number is checked against it