Published online May 26, 2020. doi: 10.4330/wjc.v12.i5.210
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
Elderly patients awaiting moderate to high-risk surgery may undergo nuclear stress testing (NST) in order to evaluate their cardiovascular risk. The prognostic utility of such testing in the very elderly (≥ 85 years) has yet to be fully evaluated. Octogenarians and nonogenarians frequently have a number of concurrent conditions including a high rate of coronary disease, and therefore the prognostic value of NST for their preoperative risk assessment has been questioned. Our evaluation assesses the ability of nuclear stress testing to predict peri-operative cardiac outcomes in this patient population.
To investigate the ability of NST to predict peri-operative cardiac outcomes in elderly patients awaiting moderate to high-risk surgery.
Patients ≥ 85 years undergoing pre-operative NST were retrospectively evaluated. Patients undergoing low-risk surgery were excluded. Major adverse cardiac events (MACE) were considered any adverse event that occurred prior to discharge and included acute heart failure, arrhythmia, acute myocardial infarction, unstable angina, or death. Associations between patient risk factors, MACE, and the obtained results of the pre-operative stress testing, ejection fraction (< 40% or ≥ 40%), summed stress score (≤ 8, ≥ 9), and the summed difference score (≤ 0, > 0) were analyzed.
A total of 69 patients (mean age 88 ± 2.6 years, 31 males) underwent nuclear stress testing prior to surgery. There were 41 (60%) patients found to have an abnormal NST. Sixteen (23%) patients were noted to experience post-operative MACE. No significant associations between risk factors and MACE were noted. Patients with an abnormal NST and/or a summed stress score ≥ 9 were significantly (P < 0.01) more likely to develop peri-operative MACE.
Indicated preoperative NST is useful to assess pre-operative risk in elderly patients ≥ 85 years undergoing moderate to high-risk surgery.
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.