Prognostic value of adenosine tri phosphate myocardial perfusion tomography in octogenarians / 中华内科杂志

ABSTRACT

Objective To evaluate the prognostic value of ~(99m)Tc-MIBI myocardial perfusion single-photon emission computed tomography (MPS) with adenosine triphosphate in patients aged 80 years or older. Methods A total of 265 patients [ mean age (84. 2 ±3.6) years old ] who underwent adenosine triphosphate and rest ~(99m)Tc-MIBI myocardial SPECT imaging were followed-up for (36. 7 ± 22. 8 ) months. Results During the period of follow-up, 57 patients (20. 4% ) suffered from cardiac events, including 20 major events: 5 cardiac death and 15 acule non-fatal myocardial infarction, 14 unstable angina pectoris,7 heart failure and 16 cases undergoing PCI. The cardiac event rate in patients with fixed or mixed perfusion defects (n = 54) was 50%, which was significantly higher lhan that in patients with reversible perfusion defects(n=67, 31. 3% ,P<0. 05) and normal perfusion imaging( n = 144, 6. 2% ,P <0. 01 ) . The major cardiac event rate in patients with fixed or mixed perfusion defects was 27. 8% , which was significantly higher than that in those with reversible perfusion defects ( 6. 0% , P < 0. 05) and normal perfusion imaging (0.7%, P < 0. 01 ) . Cox multivariate analysis revealed that an abnormal MPS was the most important independent predictor of major or total cardiac events. Conclusions ~(99m) Tc-MIBI MPS with ATP is demonstrated to be a powerful tool for the prognostic evaluation in octogenarian population. Octogenarians with a normal MPS have a low risk of major or total cardiac events, but when an abnormal MPS is present, the risk is significantly higher, being highest in patients with fixed or mixed perfusion defects.