Age and referral to coronary angiography after an abnormal treadmill thallium test
M S Lauer1, F J Pashkow, C E Snader
1Department of Cardiology, Cleveland Clinic Foundation, OH 44195, USA.
Insights
Older adults with abnormal treadmill thallium scans are less likely to receive coronary angiography. Increasing age is associated with lower referral rates, despite potential cardiac risks.
Area of Science:
- Cardiology
- Geriatric Medicine
- Diagnostic Imaging
Background:
- Abnormal treadmill thallium scans indicate potential coronary artery disease.
- Referral patterns for coronary angiography may vary by patient demographics.
- Age is a significant factor in healthcare decision-making.
Purpose of the Study:
- To examine the relationship between patient age and referral for coronary angiography.
- To assess if age influences the utilization of diagnostic cardiac procedures following an abnormal stress test.
- To investigate the impact of age on cardiac event rates in patients with abnormal thallium scans.
Main Methods:
- Retrospective analysis of 416 adult patients with abnormal treadmill thallium scans (1990-1993).
- Primary endpoint: coronary angiography within 90 days of the treadmill test.
- Statistical analysis included trend tests and adjusted regression models for confounders.
Main Results:
- Coronary angiography rates decreased significantly with increasing age: 46% (30-49 yrs), 53% (50-64 yrs), 33% (65-74 yrs), and 18% (≥75 yrs).
- Age remained a significant independent predictor of lower angiography referral rates (p < 0.0001).
- Higher mortality rates were observed in older patients (≥75 yrs), and abnormal scan segments predicted death.
Conclusions:
- Increasing age is independently associated with a reduced likelihood of referral for coronary angiography after an abnormal treadmill thallium test.
- This age-related disparity in referral may warrant further investigation, especially given higher mortality in older adults.
- The findings highlight potential undertreatment of coronary artery disease in elderly patients.
Abstract:
This study investigated the association between age and referral to coronary angiography among ambulatory adults with an abnormal treadmill thallium scan. The subjects studied were 416 consecutive adults who were > or = 30 years old, under the care of cardiologists, and had an abnormal treadmill thallium scan between 1990 and 1993 at the Cleveland Clinic Foundation. The primary end point was performance of coronary angiography within 90 days of the treadmill test. Coronary angiography was performed in 163 subjects. Coronary angiography was performed in 46% of patients aged 30-49 years, in 53% of those aged 50 to 64 years, in 33% of those aged 65 to 74 years, and in only 18% of those aged > or = 75 years (chi2 test for trend, p < 0.0001). After adjustment for potential confounders, age remained associated with a lower rate of referral to angiography (p < 0.0001). During 2 years of follow-up 34 deaths occurred (14 cardiac), with particularly high mortality rates among those aged >74 years (cumulative rate 31%, 95% confidence interval 16% to 47%). The number of abnormal thallium scan segments was predictive of death (p = 0.02). These data suggest that increasing age is associated with a lower rate of referral to coronary angiography after an abnormal treadmill thallium test.
Related Concept Videos
01:26Exercise Stress Test
Exercise stress testing, commonly known as a treadmill test, is a noninvasive procedure used to evaluate cardiovascular function and diagnose heart conditions.
Definition
An exercise stress test measures the heart's response to exertion using a treadmill or stationary bicycle. Chest electrodes record the heart's electrical activity through an ECG, and blood pressure is monitored regularly.
Purposes
01:28Imaging Studies for Cardiovascular System V: CT
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies