Abstract 603: Stress Echocardiography is an Effective Gatekeeper for Coronary Revascularization
OBJECTIVES The purpose of this study was to evaluate the impact of stress echocardiography on referral to coronary revascularization.
BACKGROUND Stress echocardiography is an established technique for diagnosis, risk stratification and prognosis of patients with known or suspected coronary artery disease. The impact of stress echocardiography on referral to coronary revascularization is not known.
METHODS We assessed 3121 patients (60±13 years, 48% male) undergoing stress echocardiography (41% treadmill, 59% dobutamine). Follow-up (2.8±1.1 years) for subsequent percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG) was obtained.
RESULTS Stress echocardiography was normal (peak wall motion score index/pWMSI = 1.0) in 66% and abnormal: pWMSI = 1.1–1.7 in 19% and pWMSI > 1.7 in 15% of patients. Late coronary revascularization (2 years following stress echocardiography, PCI% or CABG%) occurred in 80 patients (2.8%, 1.1%) with pWMSI = 1.0, 123 patients (13.5%, 7.3%) with pWMSI = 1.1–1.7 and 102 patients (12.7%, 9.6%) with pWMSI > 1.7 (Figure⇓). Multivariate logistic regression analysis identified pWMSI as the strongest predictor of coronary revascularization (RR 1.91, 95% CI 1.68 –2.17, p < 0.0001).
CONCLUSIONS Stress echocardiography is an effective gatekeeper for coronary revascularization. A normal stress echocardiography study (pWMSI = 1.0) is associated with a low rate of late coronary revascularization (2.8% PCI, 1.1% CABG). Abnormal stress echocardiography (pWMSI ≥ 1.1) impacts clinical decision making with significantly increased referral to PCI and CABG revascularization.