[Prognostic value of adenosine triphosphate myocardial perfusion tomography in octogenarians.]

To evaluate the prognostic value of (99m)Tc-MIBI myocardial perfusion single-photon emission computed tomography (MPS) with adenosine triphosphate in patients aged 80 years or older.

A total of 265 patients [mean age (84.2 +/- 3.6) years old] who underwent adenosine triphosphate and rest (99m)Tc-MIBI myocardial SPECT imaging were followed-up for (36.7 +/- 22.8) months.

During the period of follow-up, 57 patients (20.4%) suffered from cardiac events, including 20 major events: 5 cardiac death and 15 acute non-fatal myocardial infarction, 14 unstable angina pectoris, 7 heart failure and 16 cases undergoing PCI. The cardiac event rate in patients with fixed or mixed perfusion defects (n = 54) was 50%, which was significantly higher than that in patients with reversible perfusion defects (n = 67, 31.3%, P < 0.05) and normal perfusion imaging (n = 144, 6.2%, P < 0.01). The major cardiac event rate in patients with fixed or mixed perfusion defects was 27.8%, which was significantly higher than that in those with reversible perfusion defects (6.0%, P < 0.05) and normal perfusion imaging (0.7%, P < 0.01). Cox multivariate analysis revealed that an abnormal MPS was the most important independent predictor of major or total cardiac events.

(99m)Tc-MIBI MPS with ATP is demonstrated to be a powerful tool for the prognostic evaluation in octogenarian population. Octogenarians with a normal MPS have a low risk of major or total cardiac events, but when an abnormal MPS is present, the risk is significantly higher, being highest in patients with fixed or mixed perfusion defects.