Preoperative nuclear stress testing in the very old patient population

ARTICLE HIGHLIGHTS

Research background

It is common for elderly patients awaiting moderate to high-risk surgery to undergo nuclear stress testing in order to evaluate their cardiovascular risk. However, the prognostic utility of such testing in the very elderly (≥ 85 years) has yet to be evaluated.

Research motivation

The very elderly (octogenarians and nonagenarians) frequently have a number of concurrent conditions in addition to a high rate of coronary disease and therefore the prognostic value of nuclear stress testing for their preoperative risk assessment has been questioned.

Research objectives

We sought to assess the ability of nuclear stress testing to predict peri-operative cardiac outcomes in these patients.

Research methods

We undertook a retrospective descriptive study of 69 patients ≥ 85 years of age who underwent pre-operative nuclear stress testing. Patients undergoing low-risk surgery as defined by guidelines were excluded. Other exclusion criteria were patients aged less than 85, and patients undergoing resting nuclear perfusion studies (i.e., viability studies).

Research results

We found that there were no significant associations between risk factors and major adverse cardiac events (MACE). Patients with an abnormal nuclear perfusion result and/or a summed stress score ≥ 9 were significantly (P < 0.01) more likely to develop peri-operative major adverse cardiac events.

Research conclusions

Indicated nuclear stress testing is useful to assess pre-operative risk in elderly patients ≥ 85 years undergoing moderate to high-risk surgery.