Author + information
- Received June 30, 1987
- Revision received October 12, 1987
- Accepted October 12, 1987
- Published online March 1, 1988.
- Jules Y.T. Lam, MD, FACC,
- Bernard R. Chaitman, MD, FACC∗,
- Mark Glaenzer,
- Sheila Byers, RN,
- Jeannine Fite, RN,
- Yogesh Shah, MD,
- Henry Goodgold, MD and
- Larry Samuels, MD
- ↵∗Address for reprints: Bernard R. Chaitman, MD, Division of Cardiology, St. Louis University Medical Center, 1325 South Grand Boulevard, St. Louis, Missouri 63104.
The noninvasive diagnosis of coronary artery disease in the elderly can occasionally be difficult. Intravenous dipyridamole-thallium imaging is a potentially useful diagnostic test to determine presence and severity of coronary disease; however, the safety of the procedure has not been determined in an older population. The side effect profile and frequency of severe ischemic responses after 0.56 mg/kg of intravenous dipyridamole were compared in 101 patients ≥70 years old and 236 patients <70 years old. There were no side effects in 64% and 62% of patients ≥70 and <70 years old, respectively (p = NS). Among the 337 patients tested, there were no complications of myocardial infarction or death. The most common cardiac side effect was chest pain, which occurred in 21 (21%) of the 101 patients aged ≥70 years and in 64 (27%) of the 236 patients <70 years (p = NS). Aminophylline was required to reverse cardiac or noncardiac side effects in 15 (15%) and 36 (15%) of the patients ≥ 70 and <70 years old, respectively (p = NS). A severe ischemic response occurred in 2% and 2.5% of patients ≥70 and <70 years old, respectively (p = NS).
The sensitivity of intravenous dipyridamole-thallium imaging for obstructive coronary artery disease was 86% (25 of 29) and 83% (68 of 82) in older and younger patients, respectively (p = NS): the specificity was 75% (6 of 8) and 70% (16 of 23). respectively (p = NS). Thus, intravenous dipyridamole-thallium imaging is a safe noninvasive method for assessment of older patients with obstructive coronary disease; its side effect profile and diagnostic accuracy are similar to those seen in younger patients. The technique is associated with severe ischemic responses in only a small minority of patients.
- Received June 30, 1987.
- Revision received October 12, 1987.
- Accepted October 12, 1987.