Abstract 14907: Prognostic Role of Dobutamine Stress Contrast Echo in Patients With Known or Suspected Coronary Artery Disease in Different Age Groups and Its Additive Value Over Traditional Risk Factors
Purpose: Dobutamine stress contrast echo (DSCE) has been successfully implemented in clinical practice for the assessment of coronary artery disease (CAD). The aim of this study was to evaluate the prognostic role of DSCE in patients with known or suspected CAD in different age groups and its additive value over traditional risk factors.
Methods: We retrospectively studied 3502 (63.1 ± 9.1 years) consecutive patients who were referred to our department for clinically indicated DSCE. A full medical history with regards to risk factors was recorded. Ischemic response was defined as wall-motion deterioration and/or perfusion abnormality in two or more consecutive myocardial segments. Patients were divided into 3 groups according to their age: young adults (age<45yrs), middle-aged (45<age3 months) and hospitalizations.
Results: In 1194 (34.1 %) patients, ischemic response to DSCE was illustrated, whereas the remaining patients had no abnormal finding during DSCE. During follow-up end-points were noted in 616 (17.6 %) patients. Logistic regression analysis revealed that DSCE response was the strongest predictor for adverse outcomes (O.R 6.3, 2.1 to 18.4, 95% C.I), especially for middle-aged patients. 5-year event-free proportion was 0.67 ± 0.07 for ischemic responders, while for non-ischemic responders the respective rate was 0.93 ± 0.03, (p<0.05). Hazard ratio was 4.7 for patients with positive DSCE (2.02 to 11.04, 95% C.I). Sequential Cox regression models were fit to test the incremental value of dobutamine stress contrast echocardiography over clinical variables on outcome prediction. Abnormal stress increased the χ2 from 22.4 to 78.9 in comparison with clinical variables (P < 0.005).
Conclusion: Dobutamine stress contrast echo is a strong predictor of end points in patients with known or suspected CAD, especially for middle-aged patients. In addition, it appears to offer incremental value on outcome prediction over traditional risk factors.
- © 2013 by American Heart Association, Inc.