Special Subsets of Patients

  • Eugenio Picano


Individuals over 65 years of age account for 12% of the total population in the United States, twice the proportion existing 20 years ago. This group is expected to increase by 20% in the next decade and is predicted to constitute more than 20% of the population in the year 2030. Coronary artery disease accounts for two thirds of all deaths in subjects over 65 years of age, and more than 5o% of all patients admitted to the hospital with acute myocardial infarction are older than 65. Thus the identification of patients at high risk for future cardiac events is a particularly important and frequent clinical problem [1]. Pharmacological stress echocardiography with either dipyridamole [2, 3], dobutamine [4, 5], or adenosine [5] has proved to work efficiently in elderly patients both for diagnosis and prognosis. In the multicenter, observational EPIC study [2], elderly patients with positive stress echocardiography test tended to receive less coronary angiography and less revascularization procedures when compared to the overall population. The prevalence of revascularization procedures in the group with a positive dipyridamole echocardiography was 28% in the overall study group, but only 15% in the elderly group. A relatively advanced age seems to exert a protective effect in the physician’s decision concerning intervention, but this policy in time may adversely affect outcome, since a dramatic change in the natural history can be achieved by properly targeted interventions strategically oriented by the results of physiologic testing. With current advances in surgical techniques and intraoperative myocardial protection, elderly patients with multivessel disease and even significant baseline dysfunction can undergo coronary artery bypass surgery with a low in-hospital mortality rate and an excellent short-term survival rate. Thus one may never be too old for risk stratification [1] — and such risk stratification can safely and effectively be achieved by pharmacological stress echocardiography.


Coronary Artery Bypass Surgery Stress Echocardiography Revascularization Procedure Dobutamine Stress Echocardiography Major Vascular Surgery 
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Copyright information

© Springer-Verlag Berlin Heidelberg 1997

Authors and Affiliations

  • Eugenio Picano
    • 1
  1. 1.Institute of Clinical PhysiologyCNRPisaItaly

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