Is there a role for 64-multi-detector CT coronary angiography in octogenarians? A single-centre experience
There are currently limited data regarding multi-detector computed tomography (MDCT) coronary angiography in very elderly patients. This study reviews the utility of MDCT coronary angiography in octogenarians examined at our institution.
We reviewed 26 patients (mean age 83.1 ±4.6 years, range 80–96; 13 male) who attended for MDCT coronary angiography at our institution between January 2005 and January 2008. Scan indications, findings and clinical outcomes were recorded. Studies were graded according to overall image quality.
One patient was excluded because of contrast extravasation. Of the 25 complete studies, image quality was at least adequate in 72% of patients. A total of 35 significant (>50% diameter narrowing) stenoses were detected. The mean Agatston score was 1182.7 ±1080.2 in the 14/25 patients evaluated. In 6/25 patients (24%) MDCT excluded significant stenoses; in 12/25 patients (48%) one or more potentially significant stenoses were identified, a diagnosis confirmed in the four patients who underwent further investigations; in 7/25 patients (28%) the MDCT scans were of insufficient diagnostic quality.
In conclusion, MDCT coronary angiography is feasible in the majority of very elderly patients. Diagnostic scans were obtained in most octogenarian patients, allowing detection of potentially flow-limiting stenoses or exclusion of significant disease.
Very elderly individuals are the fastest growing segment of most Western populations, with those aged 80 and older projected to triple in number by the middle of this century. The prevalence of coronary artery disease is high in this age group, and diagnostic investigations are being used with increasing frequency when angina is poorly controlled by medical therapy. However, due to more extensive disease and less functional reserve, invasive investigations have a higher complication rate in the very elderly than in younger patients. Therefore, non-invasive tests that identify those patients most likely to benefit from invasive angiography would seem particularly appropriate in older individuals. Multi-detector computed tomography (MDCT) has emerged as such a technique. Currently there are only limited data regarding the use of MDCT in very elderly patients. The aim of this study was to evaluate the diagnostic yield and clinical utility of non-invasive 64-MDCT coronary angiography in octogenarians referred to our institution.
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Abstract and Introduction
Abstract
There are currently limited data regarding multi-detector computed tomography (MDCT) coronary angiography in very elderly patients. This study reviews the utility of MDCT coronary angiography in octogenarians examined at our institution.
We reviewed 26 patients (mean age 83.1 ±4.6 years, range 80–96; 13 male) who attended for MDCT coronary angiography at our institution between January 2005 and January 2008. Scan indications, findings and clinical outcomes were recorded. Studies were graded according to overall image quality.
One patient was excluded because of contrast extravasation. Of the 25 complete studies, image quality was at least adequate in 72% of patients. A total of 35 significant (>50% diameter narrowing) stenoses were detected. The mean Agatston score was 1182.7 ±1080.2 in the 14/25 patients evaluated. In 6/25 patients (24%) MDCT excluded significant stenoses; in 12/25 patients (48%) one or more potentially significant stenoses were identified, a diagnosis confirmed in the four patients who underwent further investigations; in 7/25 patients (28%) the MDCT scans were of insufficient diagnostic quality.
In conclusion, MDCT coronary angiography is feasible in the majority of very elderly patients. Diagnostic scans were obtained in most octogenarian patients, allowing detection of potentially flow-limiting stenoses or exclusion of significant disease.
Introduction
Very elderly individuals are the fastest growing segment of most Western populations, with those aged 80 and older projected to triple in number by the middle of this century. The prevalence of coronary artery disease is high in this age group, and diagnostic investigations are being used with increasing frequency when angina is poorly controlled by medical therapy. However, due to more extensive disease and less functional reserve, invasive investigations have a higher complication rate in the very elderly than in younger patients. Therefore, non-invasive tests that identify those patients most likely to benefit from invasive angiography would seem particularly appropriate in older individuals. Multi-detector computed tomography (MDCT) has emerged as such a technique. Currently there are only limited data regarding the use of MDCT in very elderly patients. The aim of this study was to evaluate the diagnostic yield and clinical utility of non-invasive 64-MDCT coronary angiography in octogenarians referred to our institution.
(Enlarge Image)
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