Detection of myocardial ischaemia in the elderly vs the young by stress Thallium-201 scintigraphy and its relation to important coronary artery disease

Hippokratia 2001, 5(2):76-83

D Psirropoulos, Ap Efthimiadis, G Boudonas, I Papadopoulos, G Papadopoulos, D Ekklisiarchos, M Parthenis, T Constantinidis, N Lefkos


The prevalence and severity of coronary atherosclerosis increase dramatically with age, that more than so mush so half of all deaths in people aged over 65 are due to coronary arterial disease (CAD) and about three fourths of all deaths from CAD occur in the elderly. The aims of our study were, firstly, to detect myocardial ischaemia development in elderly versus younger people undergoing treatment for known CAD through the use of both conventional treadmill testing and Tl201 scintigraphy, and secondly, to determine the relationship between the above non-invasive tests and angiographically confirmed important coronary artery disease (iCAD). A database from six hundred and six patients (Total=606, M=355, F=251) who had undergone coronary angiography, exercise ECG testing (ETT) using the treadmill Bruce protocol, and Tl201 scintigraphy was reviewed retrospectively. All patients had displayed clinical expressions of CAD with or without the existence of an old myocardial infarction (MI). The patients were from both sexes (M=440, F=252) and divided into two groups, according to age.Group A was composed of 265 patients aged over 65 (M=170, F=95, mean age=70.3± 5.3 years). Group Β was composed of 341 patients aged under 65 (M=185, F=156, mean age 54.4±9.1 years). Patients with uncontrolled arterial hypertension, hypertrophic cardiomyopathy, severe valve diseases, severe chronic obstructive lung diseases, severe anemia, peripheral atherosclerosis, orthopedic problems, and Parkinson’s disease were excluded from the study.The term “important coronary artery disease” (iCAD) covers the following patterns of coronary anatomy: a) left main stem stenosis > 50% with or without disease elsewhere, b) proximal three vessel disease, c) three vessel disease including the proximal LAD, d) proximal two vessel disease including LAD and e) two vessel disease including the proximal LAD.Biostatistical characteristics such as sensitivity, specificity, predictive values of ETT-Tl201 were estimated.Analyzing our results we concluded that: The biostatistical parameters in predicting important CAD in elderly and younger patients by means of exercise test and thallium scintigraphy need to be redefined through more closely scheduled and prospective studies.In elderly coronary patients the appearance of positive results in both parameters of ETT-Tl201 indicates a significant possibility of iCAD existence.In coronary patients younger than 65 years the appearance of negative results in both parameters of ETT-Tl201 almost excludes iCAD in contrast to elderly patients, who display a significant proportion of iCAD.In elderly coronary patients the appearance of equivocal results in both tests indicates a significant possibility of the existence of iCAD in contrast to younger patients.