Association between abnormal myocardial scintigraphy findings and long-term outcomes for elderly patients 85 years or older: a retrospective cohort study

Background Normal findings of cardiac scintigraphy predict good outcomes. However, a paucity of the data exists for elderly patients 85 years or older. In the present study, we aimed to demonstrate the association between the abnormal findings of cardiac scintigraphy and the risk of all cause death in patients 85 years or older. Methods We enrolled 143 consecutive patients 85 years or older with known or suspected coronary artery disease who underwent stress scintigraphy under adenosine or an exercise test and a 99m Technetium (Tc)-labeled tracer or thallium 201 ( 201 Tl), dual tracer rest scintigraphy using 201 Tl and 123 I-β-methyl iodophenyl pentadecanoic acid ( 123 I-BMIPP), or 123 I-BMIPP single tracer scintigraphy. Ischemia was defined by an induced perfusion abnormality according to a provocation test with recovery at rest or decreased uptake of 123 I-BMIPP despite normal perfusion at rest. Infarction was defined by perfusion abnormalities assessed by images at rest on 201 Tl or 99m Tc-labeled tracer. We defined these findings as abnormal when at least one of these aforementioned characteristics was observed. Results Patients in the abnormal findings group ( N = 62) were more likely to have undergone prior coronary angiography and to have decreased ejection fraction than those in the normal findings group ( N = 81). The median follow-up duration was 797 days (interquartile range, 635–1045 days), with follow-up rates of 90% at 1 year and 73% at 2 years. The 2-year mortality rate were significantly higher in the abnormal findings group than in the normal findings group (26.8% vs. 10.9%; p = 0.01). The risk of abnormal findings relative to normal findings remained significant for the mortality (adjusted hazard ratio, 5.99; 95% CI, 1.37–42.8; P = 0.015). Conclusion Abnormal myocardial scintigraphy findings were associated with the increased risk for mortality, even for patients 85 years or older.