CT pulmonary angiography in elderly patients: outcomes in patients aged >85 years

To assess the quality, safety, and outcomes following computed tomography pulmonary angiography (CTPA) performed in elderly patients.

CTPA examinations were performed in 140 patients aged >85 years in three UK acute National Health Service (NHS) hospitals. Images were assessed for quality, pulmonary emboli, and other disease entities. Patients were assessed for contrast medium-induced nephropathy (CIN), and short-term and long-term survival. Statistics included Fisher's exact, Mann-Whitney U, and logrank tests.

The mean age of patients was 92 years with baseline creatinine ranging 57-310 μmol/l. CTPA was of good quality in 79% (110/140) of cases and pulmonary emboli were demonstrated in 16% (23/140). Warfarin or inferior vena cava (IVC) filter insertion was instigated in 70% (16/23) of patients with pulmonary emboli. No patient had an immediate contrast medium reaction or required renal replacement therapy. CIN was seen following 6% (8/140) of examinations but was not predicted by baseline renal function (p = 0.62). There was a trend towards increased patient mortality in the presence of CIN, although this did not reach statistical significance (p > 0.10). Patients with pulmonary emboli had improved median survival, although this did not reach significance (28 months versus 12 months, p = 0.16). Patients with other significant diseases reported on CTPA had significantly worse median survival (4 months versus 17 months, p = 0.025).

Patients aged >85 years undergoing CTPA have a low (6%) rate of CIN: this was not predicted by baseline renal function and did not impact on survival. CTPA in elderly patients is safe, facilitates active management of pulmonary emboli, and the discovery of additional disease entities informs survival.