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: Regadenoson (REG) is a new pharmacologic vasodilator now widely used for SPECT myocardial perfusion imaging with comparable accuracy to adenosine. However little or no data is available regarding its prognostic value. We aimed to evaluate the prognostic value of REG SPECT in the elderly patient population (>75 years) when compared to those < 75 years of age.
: A retrospective analysis of 1162 consecutive patients who underwent REG SPECT in 2009 with a mean follow-up of 1.8+/- 0.8 years was performed categorizing in 2 groups (Grp 1< 75 years, n =801 and Grp 2 > 75 years, n= 361). Univariate comparisons between both groups were performed and multivariate cox regression analysis was done to identify independent predictors of cardiac MACE (cardiac death, MI and CHF). Kaplan Meir survival curves were generated for both groups.
: Patients in Grp 2(> 75 years) were more likely to be Caucasian, women with a higher prevalence of CAD, HTN, lower body surface area and CKD (GFR< 60 ml/sq m) and mainly underwent REG SPECT only without adjunctive exercise, (all p values < 0.001) SPECT variables such as summed stress and difference scores, TID and abnormal stress EKG were comparable between Grps 1 and 2 (all p values =NS). Multivariate regression analysis identified age >/=75 (p=0.001, HR 2.1, CI 1.3-3.34), EF < 50%(p=<0.001, HR 4.4, CI 2.7-7.2), prior MI(p =0.007, HR 1.6, CI 0.97-2.62) and GFR< 60 (p=<0.001, HR 2.1, CI 1.5-3.06) as independent predictors of cardiac MACE. Kaplan Meir survival curves showed that the Grp 2 had less freedom from cardiac MACE overall compared Grp 1(p=<0.001) and Grp 2 also had less freedom from cardiac MACE with low or higher risk SPECT(summed stress score < 4, p=<0.02 or > 4, p=<0.001) and when stratified as undergoing REG(p=< 0.01) or REG with adjunctive exercise (p=< 0.02).
: REG SPECT is able to effectively prognosticate elderly patients undergoing pharmacologic stress SPECT and elderly age appears to be an independent predictor of adverse cardiac outcomes despite low risk SPECT.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Prognostic Implications in Nuclear Imaging
Abstract Category: 21. Imaging: Nuclear
Presentation Number: 1315-360
- 2013 American College of Cardiology Foundation