Key result
MPS summed stress score >3 is linked to ~151% higher CAD odds in elderly patients.
Why the study?
Does the severity of ischemia on myocardial perfusion imaging predict angiographically confirmed coronary artery disease in elderly persons with suspected coronary disease?
Observational (n=322)
Does the severity of ischemia on myocardial perfusion imaging predict angiographically confirmed coronary artery disease in elderly persons with suspected coronary disease?
Odds Ratio: 2.51 (95% CI 1.43–4.39)
p-value: p=0.0013
In elderly patients with suspected coronary disease, moderate-to-severe ischemia (SDS ≥ 5) and abnormal stress perfusion (SSS > 3) on myocardial perfusion imaging are independently associated with angiographically confirmed CAD.
Should not yet change CAD evaluation thresholds in elderly patients; leaves open whether summed stress score refines risk stratification prospectively.
AIMS: Myocardial perfusion and ischemia scores obtained from myocardial perfusion scintigraphy (MPS) have strong independent prognostic value in elderly individuals without known coronary artery disease (CAD). Herein we aimed to assess their independent diagnostic value and accuracy for CAD while considering different thresholds of myocardial ischemia. METHODS: We estimated the summed rest score (SRS), summed stress score (SSS) and summed difference score (SDS) in 322 elderly individuals (mean age 72 ± 7 years, 68% men) who underwent coronary angiography following an MPS. Abnormal perfusion at stress was defined as an SSS greater than 3, and ischemia as an SDS of at least 2, and further categorized as mild (2-4), moderate (5-7) or severe (>7). Multivariate logistic regressions were used to establish the independent diagnostic value and accuracy of MPS parameters. RESULTS: CAD was diagnosed in 182 individuals (56%). In multivariate analysis accounting for clinical variables associated with CAD including the Framingham risk score, both SRS [odds ratio (OR) 1.09, 95% confidence interval (CI) 1.01-1.18, P = 0.03] and SSS (OR 1.10, 95% CI 1.04-1.16, P = 0.0006) and SDS (OR 1.12, 95% CI 1.04-1.21, P = 0.003) were independently associated with CAD. An SSS greater than 3 was also independently associated with CAD (OR 2.51, 95% CI 1.43-4.39, P = 0.0013), whereas an SDS of 2 or greater was not (OR 1.62, 95% CI 0.89-2.93, P = 0.12), but only when at least 5 (OR 2.31, 95% CI 1.32-4.03, P = 0.003). The probability of CAD was proportional to the amount of myocardial ischemia in those with an SSS greater than 3, and lower and comparable in those with an SSS of at least 3 or an SSS greater than 3 with SDS of 1 or less (P = 0.19). Increasing the threshold of myocardial ischemia determined a decrease in sensitivity and increase in specificity of MPS for both diagnosis and severity of CAD. CONCLUSION: We established the diagnostic value and accuracy of continuous scores and thresholds of abnormal myocardial perfusion and ischemia previously validated in prognostic studies. Their more widespread use could potentially improve the diagnostic yield of coronary angiography in elderly individuals with suspected CAD.
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Canepa et al. (2015) conducted an observational in Suspected coronary artery disease (n=322). Myocardial perfusion scintigraphy scores (SSS > 3) vs. SSS ≤ 3 was evaluated on Diagnosis of coronary artery disease (OR 2.51, 95% CI 1.43-4.39, p=0.0013). A summed stress score >3 on myocardial perfusion scintigraphy was independently associated with coronary artery disease in elderly patients (OR 2.51; 95% CI 1.43-4.39; P=0.0013).
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