Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
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.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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
Core Tip

Core tip: It is common practice 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. Octogenarians and nonogenarians 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. We sought to assess the ability of nuclear stress testing to predict peri-operative cardiac outcomes in these patients. We found that there were no significant associations between risk factors and major adverse cardiac events. 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. Indicated nuclear stress testing, therefore, is useful to assess pre-operative risk in elderly patients ≥ 85 years undergoing moderate to high-risk surgery.