Abstract 4231: Impact of Stress Echocardiography on Patient Outcome: An Effective Gatekeeper for Coronary Angiography
Stress echocardiography is an established technique for the diagnosis, risk stratification and prognosis of patients with known or suspected coronary artery disease. The impact of stress echo in patient selection for coronary angiography is unclear. We assessed 3121 patients (60 ± 13 years, 48% male) undergoing stress echo (41% treadmill, 59% dobutamine). Follow-up (mean 2.8 ± 1.1 years) for subsequent angiography (<<26>2 months), confirmed non-fatal myocardial infarction (n = 76) and cardiac death (n = 83) were identified. Stress echo was abnormal in 34% and normal in 66%. Peak wall motion score index (pWMSI) effectively risk stratified patients into low-normal stress echo (0.8%/year), intermediate (2.6%/year) and high (5.5%/year) risk groups (p < 0.0001). Early coronary angiography was performed in only 128 patients (1.7%) with normal stress echo and increased with worsening stress echo - 226 patients (22.9%) with pWMSI=1.1–1.7 and 191 patients (41.9%) with pWMSI>1.7. Multivariate logistic regression analysis identified pWMSI as the strongest predictor of future angiography (relative risk 2.04, 95% confidence interval 1.67–2.5, p<0.0001) and cardiac events (relative risk 2.45, 95% confidence interval 2.09 –2.88, p<0.0001). Stress echo is an effective gatekeeper for coronary angiography. The overall mortality rate for patients with normal stress echo was 0.8%/year. Only 1.7% of patients with normal stress echo were referred for early angiography.