Meta-analysis of optimal risk stratification in patients >65 years of age.
This meta-analysis evaluated the optimal noninvasive strategy for cardiac risk assessment of patients >65 years of age with known or suspected coronary artery disease using the available literature. Patients >65 years of age constitute a growing proportion of the population and have higher cardiovascular morbidity and mortality, but an optimal strategy to predict the risk of cardiac events in this group is unknown. A systematic search of MEDLINE was performed for cohort studies of ≥100 patients >65 years old with ≥12 months of follow-up that reported cardiac death and/or nonfatal myocardial infarction after any of stress myocardial perfusion imaging (MPI), stress echocardiography, or exercise tolerance testing (ETT) for known or suspected coronary artery disease. Pooled annualized event rates were calculated for each technique. Summary odds ratios (ORs) between normal and abnormal test results were calculated using a random-effects model. Seventeen studies (MPI 7, stress echocardiography 7, ETT 3) in 13,304 patients (mean age 75.5 years) were included. Abnormal compared to normal stress MPI (OR 11.8, 95% confidence interval [CI] 7.5 to 18.7) and stress echocardiography (OR 3.2, 95% CI 2.6 to 3.9) accurately stratified risk in patients. However, patients with abnormal and normal ETT results had similar cardiac event rates (OR 3.1, 95% CI 0.8 to 11.5). In conclusion, stress imaging with MPI or stress echocardiography effectively stratified risk in patients, whereas ETT alone did not.
Nuclear Cardiology Laboratory, Henry Low Heart Center, Hartford Hospital, Connecticut. USA. mrai@harthosp.org
Mridula
M
Rai
William Leslie
WL
Baker
Matthew Wayne
MW
Parker
Gary Vashon
GV
Heller
D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology*; D025401:Echocardiography, Stress; D005080:Exercise Test; D006801:Humans; D055414:Myocardial Perfusion Imaging; D018570:Risk Assessment; D012307:Risk Factors