Abstract 11266: Prognostic Implications of Normal Stress Echocardiogram in Patients With Angiographically Significant Coronary Artery Disease
Background: This purpose of this study was to examine the prognostic implications of normal stress echocardiography in patients with angiographically significant coronary artery disease (CAD).
Methods: We evaluated 260 patients (63 ± 10 years; 58% males) undergoing stress echocardiography (33% treadmill, 67% dobutamine) and coronary angiography within 3 months and without intervening coronary revascularization. All patients had significant CAD as defined by coronary stenosis =70% in major epicardial vessels or its branches (45% single vessel disease; 55% multivessel disease). The left ventricle was divided into 16 segments and scored on a 5-point scale of wall motion. Patients with abnormal stress echocardiography were defined as those with stress-induced ischemia (increase in wall-motion score of =1 grade). Followup (3.1 ± 1.2 years) for non-fatal myocardial infarction (n = 23) and cardiac death (n = 6) was obtained.
Results: Stress echocardiography effectively risk stratified normal (no ischemia, n = 91) vs. abnormal (ischemia, n = 169) groups for cardiac events (event rate 1.0%/year vs. 5.3%/year; p = 0.008)[graph]. Multivariate logistic regression analysis identified stress-induced ischemia as the strongest predictor of cardiac events (HR 5.3, 95% CI 1.5 - 17.8, p = 0.007). Cox proportional hazard model showed incremental value of stress echocardiography over angiography (Global chi2 increased from 10.9 to 18.2, p = 0.002 for cardiac events).
Conclusions: In patients with angiographically significant coronary artery disease: (1) normal stress echocardiography conferred a benign prognosis (1.0% event rate/year); (2) stress echocardiography results (no ischemia vs. ischemia) added significant incremental prognostic value to risk stratification over coronary angiography results.
- © 2010 by American Heart Association, Inc.