title: Safety and diagnostic accuracy of dipyridamole-thallium imaging in the elderly.
abstract: The noninvasive diagnosis of coronary artery disease in the elderly can occasionally be difficult. Intravenous dipyridamole-thallium imaging is a potentially useful diagnostic test to determine presence and severity of coronary disease; however, the safety of the procedure has not been determined in an older population. The side effect profile and frequency of severe ischemic responses after 0.56 mg/kg of intravenous dipyridamole were compared in 101 patients greater than or equal to 70 years old and 236 patients less than 70 years old. There were no side effects in 64% and 62% of patients greater than or equal to 70 and less than 70 years old, respectively (p = NS). Among the 337 patients tested, there were no complications of myocardial infarction or death. The most common cardiac side effect was chest pain, which occurred in 21 (21%) of the 101 patients aged greater than or equal to 70 years and in 64 (27%) of the 236 patients less than 70 years (p = NS). Aminophylline was required to reverse cardiac or noncardiac side effects in 15 (15%) and 36 (15%) of the patients greater than or equal to 70 and less than 70 years old, respectively (p = NS). A severe ischemic response occurred in 2% and 2.5% of patients greater than or equal to 70 and less than 70 years old, respectively (p = NS). The sensitivity of intravenous dipyridamole-thallium imaging for obstructive coronary artery disease was 86% (25 of 29) and 83% (68 of 82) in older and younger patients, respectively (p = NS); the specificity was 75% (6 of 8) and 70% (16 of 23), respectively (p = NS). Thus, intravenous dipyridamole-thallium imaging is a safe noninvasive method for assessment of older patients with obstructive coronary disease; its side effect profile and diagnostic accuracy are similar to those seen in younger patients. The technique is associated with severe ischemic responses in only a small minority of patients.
authors.affiliation: Department of Medicine, St. Louis, University School of Medicine, Missouri 63104.
authors.forename: J Y
authors.initials: JY
authors.lastname: Lam
authors.forename: B R
authors.initials: BR
authors.lastname: Chaitman
authors.forename: M
authors.initials: M
authors.lastname: Glaenzer
authors.forename: S
authors.initials: S
authors.lastname: Byers
authors.forename: J
authors.initials: J
authors.lastname: Fite
authors.forename: Y
authors.initials: Y
authors.lastname: Shah
authors.forename: H
authors.initials: H
authors.lastname: Goodgold
authors.forename: L
authors.initials: L
authors.lastname: Samuels
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000628:Aminophylline / Q000627:therapeutic use; D000787:Angina Pectoris / Q000139:chemically induced / Q000188:drug therapy; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004176:Dipyridamole / Q000008:administration & dosage / Q000009:adverse effects; D004338:Drug Combinations; D004341:Drug Evaluation; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D013794:Thallium Radioisotopes / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D004338:Drug Combinations; D013794:Thallium Radioisotopes; D000628:Aminophylline; D004176:Dipyridamole