Abstract 18308: Prognostic Value of Stress Echocardiography Appropriateness Criteria for Evaluation of Coronary Artery Disease
Background: Appropriateness criteria for stress echocardiography (SE) have been published to reduce the rate of inappropriate testing. There are limited data validating the prognostic value of these criteria in clinical practice.
Methods: 250 consecutive patients undergoing SE for evaluation of known or suspected coronary artery disease were classified into appropriate, uncertain and inappropriate categories according to appropriateness criteria guidelines. A positive SE was defined as the development of new wall motion abnormalities or a biphasic response. The primary end-point was the composite of myocardial infarction and death.
Results: Of the 250 SE, 120 (48%) were dobutamine studies and 130 (52%) were exercise studies. Of the 250 patients, 156 (62.4%), 71 (28.4%) and 23 (9.2%) were classified as appropriate, inappropriate and uncertain, respectively. A significantly greater proportion of studies classified as appropriate 71(45.5%) demonstrated inducible ischaemia compared to inappropriate studies 9(12.7%) or uncertain studies 4(17.4%), p<0.0001. During a median follow-up of 12.4 months (inter-quartile range 10.6 - 16.3 months), events occurred in 18 (11.5%), 2 (2.8%) and 0 patients classified as appropriate, inappropriate and uncertain respectively. Event-free survival was significantly reduced in patients with a SE demonstrating ischaemia compared to patients without inducible ischaemia, p <0.0001. Kaplan Meier curves demonstrated reduced event-free survival in patients with whose studies were classified as appropriate compared to inappropriate (p=0.01) or uncertain (p=0.05). There was no difference in event free survival between those classified as uncertain or inappropriate (p=0.48). The only independent predictors of mortality or myocardial infarction were a positive SE (hazard ratio 5.39) and left ventricular ejection fraction (hazard ratio 0.95).
Conclusion: Appropriateness criteria for evaluation of coronary artery disease have the ability to both determine the need for stress testing and identify patients at high risk of ischaemia, subsequent revascularisation and cardiac events.
- © 2013 by American Heart Association, Inc.