Diagnostic and Prognostic Value of Stress Testing in Older Persons

OBJECTIVE: To review the diagnostic and prognostic utility of exercise and pharmacologic stress testing in older individuals. DATA SOURCE: A computer-assisted search of the literature, followed by a manual reference review of pertinent articles. STUDY SELECTION: Studies addressing the use of exercise and pharmacologic stress testing for coronary artery disease (CAD) detection and prognosis were reviewed. Emphasis was placed on those studies applying these procedures to older populations. DATA EXTRACTION: Pertinent data were extracted regarding the diagnostic and prognostic accuracy and safety of exercise and nonexercise stress testing techniques in older patients. DATA SYNTHESIS: Available data from relevant articles were summarized and the merits and limitations of the available techniques discussed. CONCLUSIONS: Numerous studies over the past 2 decades support the usefulness of the exercise ECG and exercise thallium-201 perfusion scan for detecting CAD in older populations. Although exercise echocardiography generally appears to have diagnostic and prognostic accuracy similar to thallium-201 imaging, greater technical difficulty with this technique is frequently encountered in older patients. Non-exercise forms of stress testing, particularly those employing pharmacologic agents such as dipyridamole, adenosine, or dobutamine, combined with either thallium-201 scintigraphy or echocardiography, allow accurate CAD diagnostic and prognostic assessment in even very frail older patients. Additional studies are needed to compare the accuracy and cost-benefit ratio of the many stress testing modalities now available for older patients.