Key result
Ischemic CAD on hybrid CCTA-PET predicts over ~465% higher adverse event risk across age groups.
Why the study?
The prognostic utility of a sequential hybrid imaging strategy (CCTA followed by PET myocardial perfusion imaging in those with obstruction) in elderly patients remained unclear.
Does hybrid CCTA-PET imaging predict adverse cardiovascular outcomes similarly in elderly (≥65 years) versus younger (<65 years) patients with suspected coronary artery disease?
Cohort
Does hybrid CCTA-PET imaging predict adverse cardiovascular outcomes similarly in elderly (≥65 years) versus younger (<65 years) patients with suspected coronary artery disease?
Hybrid CCTA-PET imaging provides strong and comparable long-term prognostic value for predicting death, MI, or unstable angina in both elderly and younger patients with suspected CAD.
Answers are grounded in this paper and cite their sources.
Supports strong prognostic value of hybrid CCTA-PET across ages; leaves open whether findings alter management in elderly patients.
BACKGROUND: The prognostic utility of sequential hybrid imaging strategy (coronary computed tomography angiography (CCTA) followed by positron emission tomography (PET) myocardial perfusion imaging in those with obstruction) in the elderly remains unclear. We explored the predictors of adverse outcome in patients ≥65, versus those <65 years, who underwent hybrid CCTA-PET for evaluation of coronary artery disease (CAD). METHODS: O-water PET under adenosine stress. RESULTS: Mean age was 61.9 ± 9.9 years, 58.9 % were females. Elderly patients had more often obstructive CAD by CCTA, and ischemia by PET. During a median follow-up of 6.7 years, the composite adverse outcome (all-cause death, myocardial infarction, or unstable angina) occurred more often in patients ≥65, versus those <65 years (14.2 % vs. 5.6 %, p < 0.001). Ischemic CAD assessed by hybrid imaging predicted events with a hazard ratio of 5.65 (95 % CI 2.35-13.57) in older patients, and 7.01 (95 % CI 3.08-15.94) in younger patients, compared with patients without CAD. The c-statistic of a multivariable model including the hybrid CCTA-PET finding (adjusted for clinical risk predictors) for predicting the composite outcome was similar between patients ≥65, versus those <65 years (p = 0.1). There was no interaction between age category and the hybrid CCTA-PET finding for prediction of events (p = 0.9). CONCLUSION: The prognostic utility of hybrid CCTA-PET for predicting adverse events at long-term follow-up was similar between patients ≥65 and those <65 years.
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Nammas et al. (2025) conducted a cohort in suspected coronary artery disease. Hybrid CCTA-PET vs. Patients <65 years was evaluated on Composite adverse outcome (all-cause death, myocardial infarction, or unstable angina) (p=< 0.001). Ischemic CAD assessed by hybrid CCTA-PET strongly predicted adverse events in both patients ≥65 years (HR 5.65; 95% CI 2.35-13.57) and <65 years (HR 7.01; 95% CI 3.08-15.94) compared to no CAD.
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