Document Detail


Treadmill scores in elderly men.
MedLine Citation:
PMID:  14975471     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: This study seeks to further characterize the role of exercise testing in the elderly for prognosis and diagnosis of coronary artery disease. BACKGROUND: Recent exercise testing guidelines have recognized that statements regarding the elderly do not have an adequate evidence-based quality because the studies they are based on have limitations in sample size and design. The Duke Treadmill Score has been recommended for risk stratification, but recent evidence has suggested that it does not function in the elderly. METHODS: The study population consisted of male veterans (1872 patients >or=65 years; 3798 patients <65 years) who underwent routine clinical exercise testing with a mean follow-up of six years. A subset who underwent coronary angiography as clinically indicated (elderly, n = 405; younger, n= 809) were included. The primary outcome for all subjects was cardiovascular mortality with coronary angiographic findings as the outcome in those selected for angiography. RESULTS: In survival analysis, exercise-induced ST depression was prognostic in both age groups only when cardiovascular death was considered as the end point. Peak metabolic equivalents were the most significant predictor for both age groups only when all-cause death was considered as the end point. New age-specific prognostic scores were developed and found to be predictive for cardiovascular mortality in the elderly. Moreover, in the angiographic subset of the elderly, a specific diagnostic score provided significantly better discrimination than exercise ST measurements alone. For any new score, there is a need for validation in another elderly population. CONCLUSIONS: The mortality end point affected the choice of prognostic variables. This study demonstrates that exercise test scores can be helpful for the diagnosis and prognosis of coronary disease in the elderly.
Authors:
Steve Lai; Amir Kaykha; Takuya Yamazaki; Mary Goldstein; Joshua M Spin; Jonathan Myers; Victor F Froelicher
Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  43     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2004 Feb 
Date Detail:
Created Date:  2004-02-20     Completed Date:  2004-03-12     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  606-15     Citation Subset:  AIM; IM    
Affiliation:
Veterans Affairs Health Care System, Palo Alto, California 94121, USA. slai1@itsa.ucsf.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Aging* / physiology
Case-Control Studies
Cause of Death
Coronary Angiography
Coronary Disease / diagnosis*,  mortality,  physiopathology
Electrocardiography
Exercise Test*
Follow-Up Studies
Humans
Linear Models
Male
Prognosis
Proportional Hazards Models
ROC Curve
Risk Assessment
Survival Analysis
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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