Abstract 16626: Age-related Differences in Presentation and Assessed Risk of Suspected Coronary Artery Disease in the Clinic: Insights From the PROMISE Trial

Background: Coronary artery disease (CAD) prevalence increases with age, yet the clinical presentation and risk assessment associated with suspected CAD in the elderly in the contemporary era are unknown. Methods: Characteristics, clinical presentation and risk assessment for the 10,003 stable suspected CAD patients in the PROMISE trial were compared by age group. Results: Of the 29% of patients who were aged ≥65 years (n=2892), 2286 (79%) were 65-74 years and 606 (21%) were ≥75 years. Compared to younger patients, those aged ≥75 years differed in demographics, risk factors and primary symptoms. Although chest pain was still the most frequent presenting symptom, dyspnea was a more common primary presentation in older patients (Table). Of note, history of heart failure was rare, and presenting chest pain was similarly described as tightness in most regardless of age (p=0.390). Physicians assessed a third of those aged ≥75 years as having low pretest likelihood of CAD compared to Conclusions: Older patients with suspected CAD differ from younger patients in risk profiles, presentation and assessed risk of significant CAD by physicians compared to scoring algorithms. Lower estimation of likelihood of significant CAD may be the result of differences in presenting symptoms in older patients.