This meta-analysis evaluated the optimal noninvasive strategy for cardiac risk assessment
of patients >65 years of age with known or suspected coronary artery disease using
the available literature. Patients >65 years of age constitute a growing proportion
of the population and have higher cardiovascular morbidity and mortality, but an optimal
strategy to predict the risk of cardiac events in this group is unknown. A systematic
search of MEDLINE was performed for cohort studies of ≥100 patients >65 years old
with ≥12 months of follow-up that reported cardiac death and/or nonfatal myocardial
infarction after any of stress myocardial perfusion imaging (MPI), stress echocardiography,
or exercise tolerance testing (ETT) for known or suspected coronary artery disease.
Pooled annualized event rates were calculated for each technique. Summary odds ratios
(ORs) between normal and abnormal test results were calculated using a random-effects
model. Seventeen studies (MPI 7, stress echocardiography 7, ETT 3) in 13,304 patients
(mean age 75.5 years) were included. Abnormal compared to normal stress MPI (OR 11.8,
95% confidence interval [CI] 7.5 to 18.7) and stress echocardiography (OR 3.2, 95%
CI 2.6 to 3.9) accurately stratified risk in patients. However, patients with abnormal
and normal ETT results had similar cardiac event rates (OR 3.1, 95% CI 0.8 to 11.5).
In conclusion, stress imaging with MPI or stress echocardiography effectively stratified
risk in patients, whereas ETT alone did not.
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Article info
Publication history
Published online: July 16, 2012
Accepted:
May 24,
2012
Received in revised form:
May 24,
2012
Received:
March 15,
2012
Identification
Copyright
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
