Makaryus AN, Makaryus JN, Diamond JA. Preoperative nuclear stress testing in the very old patient population. World J Cardiol 2020; 12(5): 210-219 [PMID: 32547715 DOI: 10.4330/wjc.v12.i5.210]
Corresponding Author of This Article
Amgad N Makaryus, MD, Associate Professor, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States, and Chairman, Department of Cardiology, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554, United States. amakaryu@numc.edu
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Observational Study
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Makaryus AN, Makaryus JN, Diamond JA. Preoperative nuclear stress testing in the very old patient population. World J Cardiol 2020; 12(5): 210-219 [PMID: 32547715 DOI: 10.4330/wjc.v12.i5.210]
World J Cardiol. May 26, 2020; 12(5): 210-219 Published online May 26, 2020. doi: 10.4330/wjc.v12.i5.210
Preoperative nuclear stress testing in the very old patient population
Amgad N Makaryus, John N Makaryus, Joseph A Diamond
Amgad N Makaryus, John N Makaryus, Joseph A Diamond, Department of Cardiology, Northwell Health, New Hyde Park, NY, 11042, United States
Amgad N Makaryus, Department of Cardiology, Nassau University Medical Center, East Meadow, NY 11554, United States
Author contributions: Makaryus AN, Makaryus JN, Diamond JA designed the research, performed the research, analyzed the data, and wrote the paper.
Institutional review board statement: This study was reviewed and approved by the Northwell Health System Institutional Review Board (IRB# 04.08.141T).
Informed consent statement: This retrospective study with anonymized data does not require informed consent due to nonidentifiable (anonymized) data as approved by the institutional review board.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors who contributed their efforts to this manuscript.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at amakaryu@numc.edu. Consent was not obtained but the presented data are anonymized and risk of identification is low.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Corresponding author: Amgad N Makaryus, MD, Associate Professor, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States, and Chairman, Department of Cardiology, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554, United States. amakaryu@numc.edu
Received: November 8, 2019 Peer-review started: November 8, 2019 First decision: December 13, 2019 Revised: April 21, 2020 Accepted: May 12, 2020 Article in press: May 12, 2020 Published online: May 26, 2020 Processing time: 199 Days and 8.7 Hours
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.
