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  • Title: Long-term prognostic implications of myocardial perfusion imaging in octogenarians: an all-comer, cohort study.
    Author: Katsikis A, Theodorakos A, Manira V, Papaioannou S, Kolovou G, Voudris V, Koutelou M.
    Journal: Eur J Nucl Med Mol Imaging; 2017 Aug; 44(9):1547-1558. PubMed ID: 28597120.
    Abstract:
    PURPOSE: Evaluation of the long-term prognostic value of myocardial perfusion imaging (MPI) in octogenarians. METHODS: Six hundred and twenty-nine octogenarians [51% previous myocardial infarction (MI) or revascularization] who underwent single-isotope MPI (78% 201Tl, 22% 99mTc-tetrofosmin) with exercise (38% Bruce, 2% leg ergometry) or pharmacologic (58% adenosine, 2% dobutamine) stress were studied. All patients had LVEF determined by echocardiography within 1 month from MPI. Myocardial perfusion scoring was performed on a 17-segment LV-model with a 5-point grading system and three summed stress score (SSS)-based risk categories were formed [high-(SSS > 12), low-(SSS < 4), medium]. Prospective follow-up was performed to document all-cause (ACD), cardiac death (CD), MI, and revascularization. Revascularization was used to censor follow-up in survival analysis regarding ACD, CD, and CD/MI. For analysis of the CD, MI, or late revascularization (LR) composite, only revascularizations within 3 months from MPI (early revascularizations) were used for censoring. RESULTS: After 9.3 years there were 187 ACDs, 86 CDs, 28 MIs, and 77 revascularizations, including 28 early revascularizations. Adjusting for LVEF and stress-modality type, SSS was identified as an independent predictor of ACD [HR 1.03 (1.01-1.05)], CD [HR 1.05 (1.03-1.08)], CD,MI [HR 1.05 (1.02-1.07)], and CD,MI or LR [HR 1.05 (1.03-1.07)] (p ≤ 0.001 in all cases). Increased lung uptake had independent prognostic value only for the CD, MI, or LR end-point [HR 3 (1.2-7.7), p = 0.02]. Survival modeling demonstrated that LVEF and SSS, but not non-perfusion scintigraphic data provided incremental prognostic value over pre-test available clinical and historical information for all end-points. Differences between Kaplan-Meier survival curves of SSS-based risk groups were significant for all end-points (p < 0.001 in all cases). CONCLUSIONS: In octogenarians, MPI provides effective long-term risk stratification, regardless of stress type used or underlying cardiac function.
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