[Elective noninvasive test in the diagnosis of coronary disease in the aged].
OBJECTIVE
The purpose of this study was to determine the best noninvasive test to diagnose coronary artery disease in the elderly. PATTERNS 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 microgram/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.
Batlle
E
E
Servicio de Cardiología, Hospital Universitario San Carlos, Madrid.
Vilacosta
I
I
San Román
J A
JA
Peral
V
V
Hernández
M
M
Castillo
J A
JA
Graupner
C
C
Meroño
E
E
Stoermann
W
W
Herrera
D
D
Sánchez-Harguindey
L
L
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003627:Data Interpretation, Statistical; D004176:Dipyridamole; D004280:Dobutamine; D004452:Echocardiography / Q000379:methods; D005069:Evaluation Studies as Topic; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity
D004280:Dobutamine; D004176:Dipyridamole
Prueba no invasiva de elección en el diagnóstico de enfermedad coronaria en el anciano.