Background: Myocardial perfusion g-SPECT method in the diagnosis and decision making in the very elderly (>75) remains scarce in its evidence. We conducted research to evaluate the added value g-SPECT perfusion in the diagnosis, risk stratification and decision making in patients with suspected or diagnosed coronary artery disease (CAD).

Methods and Results: We retrospectively evaluated the results of 183 patients aged ≥65 years with clinical suspected CAD. Exclusion criteria: structural heart disease, dilated-hypertrophic myocardiopathy, hemodynamic instability. G-SPECT: Technetium-99m sestamibi (8 mCi rest-16 mCi stress); stress test according clinical conditions (pharmacological, only stress or mixed). Imaging acquisition: SIEMENS®-Symbia-S equipment with IQ-SPECT technology, and evaluated subjectively in 17 segment analysis. Mean age was 72 ± 5.50 years old (88% 65-79 and 12% >80); 126 (70%) had ischemia: 63 (65%) mild, 51 (28%) moderate, and 12 (7%) severe; 28% with FEVI>45%. Twenty one (33%) with moderate or severe ischemia were derived to catheterization; 12 underwent stent placement, 2 surgical revascularization; and, 7 continued medical treatment.

Conclusion: G-SPECT, even conducting with stress, is a safety non-invasive test with high diagnosis accuracy in the very elderly. It adds value in the decision making and reduces the risk of referring unnecessary catheterization, represents a gatekeeper option and a turn for better prognosis.