Abstract
Efficient diagnostic approaches to detect coronary artery disease (CAD) in elderly patients are necessary to ensure optimal and timely treatment. The population of suspected CAD patients older than 70 years is especially vulnerable and constantly growing. Finding the optimal diagnostic approach is challenging due to certain features of this population, such as high prevalence of comorbidities, existing contraindications to exercise tests or cognitive decline, which hinders correct assessment of the patient’s situation. Moreover, some symptoms of CAD can have variable significance in the elderly compared to younger adult groups. In this review, we present current recommendations of the United States (US) and European cardiologists’ associations and discuss their applicability for diagnostics in the elderly population. Exercise electrocardiogram (ECG) and exercise stress echocardiography (SE) tests are not feasible for a substantial proportion of elderly patients. Coronary computed tomography angiography (CTA) appears to be an attractive alternative for such patients, but is not universally applicable; for instance, it is problematic in patients with significant calcification of the vessels. Moreover, more studies are needed to compare the results delivered by CTA to those of other diagnostic methods. Future efforts should be focused on comparative studies to better understand the limits and advantages of different diagnostic methods and their combinations. It is possible that some of the currently used diagnostic criteria could be improved to better accommodate the needs of the elderly population.
Highlights
Demand for diagnostic methods of coronary artery disease (CAD) in the elderly is constantly growing, possibly due to increasing life expectancy, the growth of the elderly population and the direct link between the risk of CAD and older age
European recommendations for the management of stable CAD published in 2013 use the model proposed by Genders et al, which is an update of the Diamond and Forrester model based on the results of a clinical study including 2260 patients, 570 of whom were older than 70 years [7,17]
Among noninvasive tests for diagnosis of stable CAD, ECG exercise testing remains the most frequently used due to availability, simplicity and lower cost compared to imaging methods
Summary
Demand for diagnostic methods of coronary artery disease (CAD) in the elderly is constantly growing, possibly due to increasing life expectancy, the growth of the elderly population and the direct link between the risk of CAD and older age. Prevalence of asymptomatic CAD reported in some studies [12] was so high that it would necessitate noninvasive diagnostic procedures for any elderly patient, which is not in line with any of the published guidelines for stable CAD management. The most frequently used model for evaluation of PTP of obstructive CAD was that developed by Diamond and Forrester, published in 1979 [20] This model is used in the current US recommendations for the diagnosis and management of patients with stable CAD [12]. European recommendations for the management of stable CAD published in 2013 use the model proposed by Genders et al, which is an update of the Diamond and Forrester model based on the results of a clinical study including 2260 patients, 570 of whom were older than 70 years [7,17].
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