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Coronary artery stenoses more often overestimated in older patients: Angiographic stenosis overestimation in elderly
Nanette M Borren1, Jan Paul Ottervanger1, Martijn A Reinders1
1Department of Cardiology, Isala, Zwolle, The Netherlands.
Insights
Increasing age is a strong predictor of overestimating coronary artery stenosis severity via angiography. Functional measurements are recommended, especially for elderly patients, to prevent unnecessary revascularization.
Area of Science:
- Cardiology
- Medical Imaging
- Geriatrics
Background:
- Angiographic assessment of coronary artery stenosis can overestimate severity.
- This overestimation may lead to unnecessary revascularization procedures.
- Prevalence of overestimation may increase with patient age.
Purpose of the Study:
- To determine if patient age independently predicts angiographic overestimation of coronary artery stenosis severity.
- Investigate the relationship between age and the accuracy of stenosis assessment.
Main Methods:
- Fractional flow reserve (FFR) was used to functionally assess 335 coronary lesions in 260 stable coronary artery disease patients.
- Overestimation was defined as significant stenosis on angiography with a normal FFR (>0.80).
- Age was analyzed continuously and by quartiles, with multivariable analyses adjusting for baseline variables.
Main Results:
- The overall rate of overestimation was 11%.
- Patients with overestimation were significantly older (mean age 69 vs. 65 years, p=0.01).
- The highest age quartile showed significantly higher overestimation rates (22% vs. 8.0%, p<0.001), with an adjusted odds ratio of 3.15.
Conclusions:
- Advanced age is a significant and independent predictor of angiographic overestimation of coronary stenosis.
- Functional assessment of coronary stenoses is crucial, particularly in elderly individuals, to guide appropriate treatment and avoid unnecessary interventions.
Background:
Angiographic overestimation of coronary artery stenosis severity may result in unnecessary revascularization and is possibly more prevalent with increasing age.
Aim:
To identify whether age is an independent clinical predictor for angiographic overestimation of a coronary artery stenosis.
Methods:
Fractional flow reserve (FFR) of 335 coronary lesions was performed in 260 consecutive patients with stable coronary artery disease (CAD). Overestimation was defined as an angiographically significant stenosis, with normal FFR (>0.80). Age was analysed as both continuous variable and quartiles. The highest age quartile was compared to the remaining quartiles. Multivariable analyses were performed to adjust for differences in baseline variables.
Results:
Mean age of the total population was 65±10years, overestimation was observed in 11%. Mean age of patients with overestimation was 69±11years, compared to 65±10years in those without overestimation (p=0.01). Overestimation was observed significantly more often in the highest age quartile (22%) in comparison with the younger patients (8.0%) (p<0.001). The adjusted odds ratio for overestimation in the highest quartile group was 3.15 (95% confidence interval: 1.48-6.69).
Conclusion:
Increasing age is a strong and independent predictor for angiographic overestimation of the severity of a coronary stenosis. Functional measurement of coronary artery stenoses should be considered more often, particularly in elderly to avoid unnecessary revascularization.
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