Safety and tolerability of adenosine stress myocardial perfusion scintigraphy in the evaluation of coronary artery disease in the elderly patients - A case control study

Elderly patients referred for evaluation of chest pain are often unable to undertake adequate exercise for exercise stress testing. The aim of this retrospective study was to analyze haemodynamic effects and assess the safety of adenosine stress myocardial perfusion scintigraphy (MPS) in the elderly. Records of 380 Patients (Age range=30-93 years) were reviewed. These were divided into two groups, Group-A with 190 patients who were above 65 years of age and Group-B with 190 patients who were equal or below the age of 65 years, and who had undergone adenosine stress MPS. The two groups were matched for major risk factors and clinical presentations. Symptoms (flushing, headache, chest pain, dyspnoea, neck pain) were recorded throughout the adenosine infusion. Baseline blood pressure, heart rate and ECG were recorded and monitored throughout the study. A total of 167 out of 380 patients (44%) had side effects, 86 of them belonged to Group-A and 81 of them belonged to Group-B. Flushing occurred in 33% of patients in Group-A and 43% of patients in Group-B. Seventeen percent of patients in Group-A had chest pain, while this was encountered in 27% of patients in Group-B. Dyspnoea was recorded in 32% of patients from Group-A, while it was encountered in 21% of patients belonging to Group-B. Neck pain was experienced by 8.4% in Group-A and 15% in Group-B. All of these findings were statistically significant (p<0.05). Several other side effects were also encountered which included headache (Group-A: 14% and Group-B: 21%), abdominal discomfort (Group-A: 19% and Group-B: 23%), Nausea and/or vomiting (Group-A: 4.7% and Group-B: 7.3%). ECG changes were noted in both groups (Group-A: 14% and Group-B: 12%). None of these were found to be statistically significant. Based on this retrospective study, the authors concluded that Adenosine stress MPS is a safe method for the evaluation of coronary artery disease (CAD) in elderly patients and is well tolerated. Most side effects were less common in those over 65 years of age, except for dyspnoea, which was found to be more common in the elderly than those patients who were less than 65 years of age. (author)