title: Long-term prognostic value of myocardial perfusion imaging in octogenarians able to undergo treadmill exercise stress testing.
abstract: 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.
authors.affiliation: Nuclear Medicine Department, Onassis Cardiac Surgery Center, Athens, Greece, tkatsikis@hotmail.com.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Katsikis
authors.forename: Athanasios
authors.initials: A
authors.lastname: Theodorakos
authors.forename: Spyridon
authors.initials: S
authors.lastname: Papaioannou
authors.forename: Virginia
authors.initials: V
authors.lastname: Tsapaki
authors.forename: Genovefa
authors.initials: G
authors.lastname: Kolovou
authors.forename: Alexandros
authors.initials: A
authors.lastname: Drosatos
authors.forename: Maria
authors.initials: M
authors.lastname: Koutelou
mesh_terms: D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D018572:Disease-Free Survival; D005080:Exercise Test / Q000706:statistics & numerical data*; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D055414:Myocardial Perfusion Imaging / Q000706:statistics & numerical data*; D010358:Patient Participation / Q000706:statistics & numerical data; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate; D015899:Tomography, Emission-Computed, Single-Photon / Q000706:statistics & numerical data*