Long-term prognostic value of myocardial perfusion imaging in octogenarians able to undergo treadmill exercise stress testing.

Background: Although the use of myocardial perfusion imaging (MPI) for prognostic purposes in general population is well understood, its role in very elderly patients is not extensively studied.

Methods: 247 octgogenarians (79% male, 56% previous myocardial infarction-MI or revascularization) who underwent treadmill exercise testing (TET) with MPI were studied. TET and MPI-related data were registered per patient and prospective follow-up was performed to document all cause death (ACD), cardiac death (CD), non-fatal MI, and late revascularization (LR). Kaplan-Meier and Cox-regression analysis were used to compute event-free survival and identify significant predictors of these events.

Results: After 7.3 years there were 48 deaths, 17 CDs, 8 MIs, and 21 LRs. 69 patients were classified as high and 103 as low risk by SSS with annual cardiac mortality rates of 5% and 0.9%, respectively. Differences between survival curves of SSS-based risk groups were significant for ACD, CD, CD/MI, and CD/MI/LR. Summed stress (SSS) and difference scores were the only significant predictors of all endpoints. LVEF and transient ischemic LV dilatation were significant predictors of CD and CD/MI. LVEF and all MPI variables were associated with the CD, MI, and LR endpoint while only Duke treadmill score and angina severity demonstrated such a relationship among TET variables.

Conclusions: In octogenarians, MPI provides effective long-term risk stratification for both hard (ACD, CD, CD/MI) and soft (CD/MI/LR) endpoints and should be preferred over simple TET.