Preoperative nuclear stress testing in the very old patient population

• 作者: Amgad N Makaryus John N Makaryus Joseph A Diamond
• 来源期刊: 世界心脏病学杂志:英文版(电子版)
• 学科: 医学
• 关键词: Pharmacologic nuclear stress testing PROGNOSIS ELDERLY Preoperative assessment OUTCOMES
• 年，卷（期）: 2020,（5）
• 页码范围: 210-219
• 页数: 10页
• 分类号: R619

摘要

BACKGROUND Elderly patients awaiting moderate to high-risk surgery may undergo nuclear stress testing(NST)in order to evaluate their cardiovascular risk.The prognostic utility of such testing in the very elderly(≥85 years)has yet to be fully evaluated.Octogenarians and nonogenarians frequently have a number of concurrent conditions including a high rate of coronary disease,and therefore the prognostic value of NST for their preoperative risk assessment has been questioned.Our evaluation assesses the ability of nuclear stress testing to predict peri-operative cardiac outcomes in this patient population.AIM To investigate the ability of NST to predict peri-operative cardiac outcomes in elderly patients awaiting moderate to high-risk surgery.METHODS Patients≥85 years undergoing pre-operative NST were retrospectively evaluated.Patients undergoing low-risk surgery were excluded.Major adverse cardiac events(MACE)were considered any adverse event that occurred prior to discharge and included acute heart failure,arrhythmia,acute myocardial infarction,unstable angina,or death.Associations between patient risk factors,MACE,and the obtained results of the pre-operative stress testing,ejection fraction(<40%or≥40%),summed stress score(≤8,≥9),and the summed difference score(≤0,>0)were analyzed.RESULTS A total of 69 patients(mean age 88±2.6 years,31 males)underwent nuclear stress testing prior to surgery.There were 41(60%)patients found to have an abnormal NST.Sixteen(23%)patients were noted to experience post-operative MACE.No significant associations between risk factors and MACE were noted.Patients with an abnormal NST and/or a summed stress score≥9 weresignificantly(P<0.01)more likely to develop peri-operative MACE.CONCLUSION Indicated preoperative NST is useful to assess pre-operative risk in elderly patients≥85 years undergoing moderate to high-risk surgery.