Abstract 15028: Appropriateness Of Stress Echocardiography In Asymptomatic Patients Post Revascularization
Background: Although stress echo (SE) in asymptomatic patients (pts) is thought inappropriate early after revascularization (E-RVS), its appropriateness is indeterminate late after revascularization (L-RVS; >2y post-PCI and >5y post CABG). The aim of this study was to identify whether this distinction could be supported by outcomes.
Method: 2107 asymptomatic pts (64±10y, 15% women, 40% past MI) underwent SE early (E, n=709) and late (L, n=433) after PCI, and E (n=527) and L (n=435) after CABG. Ischemia was identified as new or worsening wall motion abnormality. Repeat RVS was attributed to SE results if it was performed within 6 months, and pts were followed for an average of five years.
Results: Ischemia was identified in 262 pts (12%). Repeat RVS (n=354, 17%) was associated with E-ischemia (28%) and L-ischemia (38%, p<.001). Cardiac death (CD) occurred in 76 non-ischemic pts, among whom mortality was 0.68%/yr in repeat RVS and 0.82%/yr in the remainder (p=0.15). There were 21 CD in ischemic pts, among whom mortality was 1.44%/yr in repeat RVS and 2.05%/yr in the remainder (p=0.38). The Figure shows no difference in CD between ischemic pts without RVS and the remainder.
Conclusion: Although ischemia is associated with adverse outcome, and SE identifies ischemia in 12% pts post-RVS, this diagnosis rarely results in repeat RVS or change in outcome. Routine SE in asymptomatic pts post RVS appears to be inappropriate at any time post RVS.
- © 2011 by American Heart Association, Inc.