In the current issue of Cardiovascular Innovations and Applications volume 4, issue 1, pp. 63-69(7); DOI https://doi.org/10.15212/CVIA.2019.0005, Saurabh Malhotra, MD, MPH, FACC, FASNC and Rami Doukky, MD, MSc, FACC, FASNC, FASE, from the Division of Cardiology, Cook County Health, Chicago, IL, USA and the Division of Cardiology, Rush University, Chicago, IL USA consider differential impacts of appropriate use criteria on the association between age and abnormal stress myocardial perfusion SPECT.
The diagnostic and prognostic value of appropriate use criteria (AUC) for coronary artery disease (CAD) is well established. Whether the diagnostic yield of AUC for predicting CAD is preserved among the elderly is not known. Age is a strong independent predictor of abnormal single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) and inducible myocardial ischemia. The value of age in predicting abnormal SPECT MPI is maintained across MPI test appropriateness categories. Appropriate testing identifies a greater prevalence of abnormal MPI in patients younger than 60 years of age, although it does not provide such a diagnostic discrimination among elderly patients. Cautious reliance on AUC is advised when one is considering elderly patients for MPI.