Diagnostic value of ischemia severity at myocardial perfusion imaging in elderly persons with suspected coronary disease

The predictive value of CRP/albumin ratio (CAR) in the diagnosis of ischemia in myocardial perfusion scintigraphy

INTRODUCTION AND OBJECTIVES

Ischemic heart disease (IHD) is the leading cause of mortality worldwide, and finding cheap and accurate screening tests is crucial. This study aimed to evaluate the predictive value of C-reactive protein (CRP)/albumin ratio (CAR) in the diagnosis of IHD using myocardial perfusion imaging (MPI).

METHODS

In this cross-sectional study, a total of 112 patients were investigated to find any relationship between CAR and myocardial ischemia by using myocardial perfusion scintigraphy. Data were analyzed using SPSS, with a P-value below 0.05 considered statistically significant.

RESULTS

Eighty-eight patients had normal MPI. Twenty-two patients had some degree of myocardial ischemia in MPI. The normal MPI and pathological MPI groups were similar in terms of sex, weight, smoking, family history of IHD, albumin levels, diabetes mellitus status, hyperlipidemia, and chest pain type. The CRP, and CAR means in the patients with myocardial ischemia were significantly higher than those with normal MPI.

CONCLUSION

Although the value of CAR was significantly higher in patients with myocardial ischemia compared to subjects with normal MPI and it was an independent predictor of IHD, the capability of CAR in diagnosing myocardial ischemia was not very strong with a sensitivity and specificity of about 60%.

Beta-blocker therapy reduces mortality in patients with coronary artery disease treated with percutaneous revascularization: a meta-analysis of adjusted results

AIMS

The long-term impact of beta blockers on prognosis in patients treated with contemporary therapies for coronary artery disease remains to be defined.

METHODS AND RESULTS

All observational studies evaluating the impact of beta blockers in patients treated with coronary revascularization and contemporary therapies and adjusted with multivariate analysis were included. All-cause death was the primary endpoint, while Major Adverse Cardiac Events (MACE) (composite endpoint of all-cause death or myocardial infarction, MI) and MI were secondary endpoints. A total of 26 studies were included, with 863 335 patients. After 3 (1-4.3) years, long-term risk of all-cause death was lower in patients on beta blockers [odds ratio, OR 0.69 (0.66-0.72)], both for Acute Coronary Syndrome (ACS) [OR 0.60 (0.56-0.65)], and stable angina patients [OR 0.84 (0.78-0.91)], independently from ejection fraction [OR 0.64 (0.42-0.98) for reduced ejection fraction and OR 0.79 (0.69-0.91) for preserved ejection fraction]. The risk of long-term MACE was lower but NS for ACS patients treated with beta blockers [OR 0.83 (0.69-1.00)], as in stable angina. Similarly, risk of MI did not differ between patients treated with beta blockers or without beta blockers [OR 0.99 (0.89-1.09), all 95% confidence intervals]. Using meta-regression analysis, the benefit of beta blockers was increased for those with longer follow-up. The number needed to treat was 52 to avoid one event of all-cause death for ACS patients and 111 for stable patients.

CONCLUSION

Even in percutaneous coronary intervention era, beta blockers reduce mortality in patients with coronary artery disease, confirming their protective effect, which was consistent for both ACS and stable patients indifferently of preserved or reduced ejection fraction.

Prognostic accuracy of myocardial perfusion imaging in octogenarians

BACKGROUND

Myocardial perfusion imaging (MPI) has an established role in the work-up of coronary artery disease (CAD), but its comparative accuracy is debated in elderly patients. We examined a large administrative database to appraise the performance of MPI in octogenarians.

METHODS

Our institutional database was queried for patients undergoing MPI without recent coronary revascularization or myocardial infarction (MI). We compared baseline, procedural, diagnostic, and prognostic features in patients aged < 80 vs ≥ 80 years with bivariate and propensity-adjusted analyses.

RESULTS

From 13,254 patients, 12,737 (96.1%) were < 80 years old and 517 (3.9%) ≥ 80 years. Octogenarians were less likely to undergo exercise testing, had more severe and extensive myocardial ischemia (all P < 0.001), whereas CAD was more prevalent and diffuse in them (P = 0.012), and major adverse cardiac events more common during follow-up (P = 0.009). Diagnostic accuracy of MPI was similar or higher in octogenarians than in younger patients (e.g., sensitivity for three-vessel disease 92% in octogenarians vs 91% in younger patients), as was prognostic accuracy. Using propensity-matched analyses, MPI again yielded satisfactory prognostic accuracy in octogenarians.

CONCLUSIONS

Use of MPI in octogenarians is associated with similar or better prognostic accuracy than in younger subjects.