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[Progression of coronary atherosclerosis and the non-invasive evaluation in older patients]
1Department of Medicine and Geriatrics, Kochi Medical School.
Insights
Dipyridamole myocardial perfusion scintigraphy (DMPS) aids in assessing coronary artery disease. Older patients with less severe disease had fewer risk factors, while progression of atherosclerosis was linked to cardiac events.
Area of Science:
- Cardiology
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Coronary atherosclerosis is a significant health concern, particularly in older populations.
- Understanding coronary risk factors and their relation to disease severity is crucial for patient management.
- Dipyridamole myocardial perfusion scintigraphy (DMPS) is a diagnostic tool for evaluating coronary artery disease (CAD).
Purpose of the Study:
- To characterize coronary atherosclerosis in older patients.
- To determine the role of DMPS in assessing patients with CAD.
- To evaluate the relationship between coronary risk factors and atherosclerosis severity/progression.
Main Methods:
- 437 patients underwent coronary angiography (CAG) and DMPS.
- Coronary risk factors (hypercholesterolemia, diabetes, hypertension, family history, smoking) were assessed.
- Follow-up included repeated CAG in 27 patients to evaluate disease progression and cardiac events over 39 months.
Main Results:
- Older patients (≥65 years) with less severe CAD showed lower prevalence of hypercholesterolemia and positive family history.
- No significant differences in diabetes, hypertension, or smoking history were found between age groups with less severe CAD.
- Progression of coronary atherosclerosis was observed in patients with increased angina and new myocardial infarction, often associated with multiple risk factors.
Conclusions:
- DMPS is valuable in assessing patients with suspected or known coronary artery disease.
- Age influences the prevalence of certain coronary risk factors in patients with varying degrees of atherosclerosis.
- Progression of coronary atherosclerosis is linked to adverse cardiac events and is associated with the burden of risk factors.
Abstract:
To evaluate characteristics of coronary atherosclerosis in older patients and to elucidate the role of dipyridamole myocardial perfusion scintigraphy (DMPS) in the assessment of patients with coronary artery disease, 437 patients (330 men, 107 women, age range 13-85 years) initially underwent coronary angiography (CAG) and DMPS. Coronary risk factors were evaluated in relation to the severity and progression of coronary atherosclerosis. Cardiac events were also evaluated during the follow-up period of 39 +/- 19 months (range 1-77 months). Assessment of five coronary risk factors, including hypercholesterolemia, diabetes, hypertension, positive family history, and history of smoking, was made in 212 patients in relation to the severity of coronary atherosclerosis. In patients with insignificant lesions or single vessel disease, prevalence of hypercholesterolemia and positive family history was lower in older patients (65 years or older) than in younger patients (64 years or younger), but significant difference was not found in prevalence of diabetes, hypertension, and history of smoking. In patients with multivessel disease, there was no significant difference in prevalence of coronary risk factors between the two groups except history of smoking. Repeated CAG was performed in 27 patients during follow-up. Nineteen of them experienced increased symptoms of angina and eight patients newly developed acute myocardial infarction. The patients with increased angina had more risk factors, and majority of them (74%) showed some progression of previously noted severe stenoses in the proximal coronary arteries. In patients with new infarction, 62% of them showed new total occlusions as infarct-related lesions, although there were some patients who showed progression of previously noted severe lesions. DMPS was performed in 437 patients.(ABSTRACT TRUNCATED AT 250 WORDS)