Preoperative nuclear stress testing in the very old patient population

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.