Risk stratification for large artery or chronic coronary artery disease-related ischemic stroke in octogenarians undergoing exercise stress myocardial perfusion imaging: A cohort study

To test, if in octogenarians, treadmill exercise with myocardial perfusion imaging (exercise-mpi) can risk stratify for large artery or chronic cad-related ischemic stroke (laccis). exercise-mpi-related data of 237 octogenarians (55% prior mi or revascularization) without previous stroke were registered and prospective follow-up was performed to document laccis. laccis was defined as acute onset of neurological symptoms with ct/mri findings of non-lacunar-type infarcts in the absence of atrial fibrillation or intracardiac embolic sources. after 7.3 years, 10 laccis were documented. sss [hr 1.08 (1.02-1.13 95% cis), sds [hr 1.1 (1.04-1.16 95% cis)], and non-sustained vt or transient av block during exercise [hr 3.9 (1.7-9.0 95% cis)] were predictors of laccis (p < .01 for all). a sss threshold of 16 had 81% specificity for identification of future laccis and risk groups formed according to this cut-off had significantly different laccis-free survival (p = .015). exercise-mpi in octogenarians can provide risk stratification markers for laccis.