Coronary artery stenoses more often overestimated in older patients: Angiographic stenosis overestimation in elderly

Background: Angiographic overestimation of coronary artery stenosis severity may result in unnecessary revascularization and is possibly more prevalent with increasing age.

Aim: To identify whether age is an independent clinical predictor for angiographic overestimation of a coronary artery stenosis.

Methods: Fractional flow reserve (FFR) of 335 coronary lesions was performed in 260 consecutive patients with stable coronary artery disease (CAD). Overestimation was defined as an angiographically significant stenosis, with normal FFR (>0.80). Age was analysed as both continuous variable and quartiles. The highest age quartile was compared to the remaining quartiles. Multivariable analyses were performed to adjust for differences in baseline variables.

Results: Mean age of the total population was 65±10years, overestimation was observed in 11%. Mean age of patients with overestimation was 69±11years, compared to 65±10years in those without overestimation (p=0.01). Overestimation was observed significantly more often in the highest age quartile (22%) in comparison with the younger patients (8.0%) (p<0.001). The adjusted odds ratio for overestimation in the highest quartile group was 3.15 (95% confidence interval: 1.48-6.69).

Conclusion: Increasing age is a strong and independent predictor for angiographic overestimation of the severity of a coronary stenosis. Functional measurement of coronary artery stenoses should be considered more often, particularly in elderly to avoid unnecessary revascularization.