{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T09:48:46Z","timestamp":1791971326052,"version":"4.3.4"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Myocardial perfusion imaging is used to guide risk stratification and revascularization decisions. We aimed to determine whether the prognostic value of ischemia on myocardial perfusion imaging and the association with early revascularization (ER) and outcomes differ across age groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>We included 73\u2009038 patients who underwent single photon emission computed tomography (n=45\u2009252) or positron emission tomography (n=27\u2009786) myocardial perfusion imaging across 20 sites from 2009 to 2024. ER was defined as revascularization within 90 days post-myocardial perfusion imaging. Propensity score-adjusted Cox models evaluated the interaction between age, ischemic burden (myocardial flow reserve for positron emission tomography), and ER for the primary outcome of all-cause death or nonfatal myocardial infarction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Median age was 66 years; 45.3% were &lt;65, 31.5% were 65 to 74, 19.1% were 75 to 84, and 4.2% were \u226585. ER was performed in 6.1%, rising to 7.0% in those aged 75 to 84 years and decreasing to 6.5% in those aged \u226585 years. During a median follow-up of 3.7 years, 10\u2009757 deaths\/myocardial infarctions occurred. Increasing ischemia was associated with lower event rates after ER versus medical therapy across most age groups, with no significant continuous age-ischemia-ER interaction (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.748). In an exploratory analysis of 3031 patients aged \u226585 years, this association appeared attenuated (hazard ratio for ischemia &gt;10%: 0.90 [0.64\u20131.26]), although precision was limited, likely reflecting, in part, the small number of patients undergoing ER (n=198). Among positron emission tomography patients, the myocardial flow reserve\u00d7ER association did not vary with age (3-way interaction\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.689). In analyses excluding patients with ER, ischemia remained prognostic in all age groups, though its associated risk declined with advancing age.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Ischemia remains prognostic across all ages and may help identify candidates who have improved outcomes with ER. In an exploratory analysis, this association appeared attenuated in patients aged \u226585 years, a hypothesis-generating observation. Positron emission tomography-derived myocardial flow reserve may provide complementary physiological information for treatment selection in older adults.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circimaging.126.019932","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T09:00:16Z","timestamp":1791968416000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Use of Myocardial Perfusion Imaging to Guide Prognosis and Management in Older Adults: Is There an Age Limit?"],"prefix":"10.1161","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0512-8444","authenticated-orcid":true,"given":"Krishna K.","family":"Patel","sequence":"first","affiliation":[{"name":"Department of Medicine (Cardiology) and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (K.K.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4676-2433","authenticated-orcid":true,"given":"Robert J.H.","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada (R.J.H.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1531-880X","authenticated-orcid":true,"given":"Mark","family":"Lemley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5199-3071","authenticated-orcid":true,"given":"Aakash","family":"Shanbhag","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3730-5075","authenticated-orcid":true,"given":"Giselle","family":"Ramirez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna X.","family":"Liang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2187-4076","authenticated-orcid":true,"given":"Wanda","family":"Acampa","sequence":"additional","affiliation":[{"name":"Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (W.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy M.","family":"Bateman","sequence":"additional","affiliation":[{"name":"Saint Luke\u2019s Mid America Heart Institute, Kansas City, MO (T.M.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1462-1185","authenticated-orcid":true,"given":"Sharmila","family":"Dorbala","sequence":"additional","affiliation":[{"name":"Cardiovascular Imaging Program, Departments of Radiology and Medicine, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Cardiovascular Division, Department of Medicine, Brigham and Women\u2019s Hospital, Boston, MA (S.D., M.D.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2583-9278","authenticated-orcid":true,"given":"Andrew J.","family":"Einstein","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital (A.J.E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Timothy","family":"Hauser","sequence":"additional","affiliation":[{"name":"Department of Nuclear Cardiology, Oklahoma Heart Hospital (M.T.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9451-5210","authenticated-orcid":true,"given":"Philipp A.","family":"Kaufmann","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Switzerland (P.A.K., R.R.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2561-4282","authenticated-orcid":true,"given":"Attila","family":"Feher","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (A.F., E.J.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2156-5962","authenticated-orcid":true,"given":"Edward 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