Prognostic value of dobutamine stress echocardiography in patients with previous coronary revascularisation
M Bountioukos1, A Elhendy, R T van Domburg
1Thoraxcentre, Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
Objective:
To assess the prognostic value of dobutamine stress echocardiography (DSE) in patients with previous myocardial revascularisation.
Design:
Prospective study.
Setting:
Tertiary referral centre in Rotterdam, the Netherlands.
Patients:
332 consecutive patients with previous percutaneous or surgical coronary revascularisation underwent DSE. Follow up was successful for 331 (99.7%) patients. Thirty eight patients who underwent early revascularisation (
Main Outcome Measures:
Cox proportional hazards regression models were used to identify independent predictors of the composite of cardiac events (cardiac death, non-fatal myocardial infarction, and late revascularisation).
Results:
During a mean (SD) of 24 (20) months, 37 (13%) patients died and 89 (30%) had at least one cardiac event (21 (7%) cardiac deaths, 11 (4%) non-fatal myocardial infarctions, and 68 (23%) late revascularisations). In multivariate analysis of clinical data, independent predictors of late cardiac events were hypertension (hazard ratio (HR) 1.7, 95% confidence interval (CI) 1.1 to 2.6) and congestive heart failure (HR 2.1, 95% CI 1.3 to 3.2). Reversible wall motion abnormalities (ischaemia) on DSE were incrementally predictive of cardiac events (HR 2.1, 95% CI 1.3 to 3.2).
Conclusions:
Myocardial ischaemia during DSE is independently predictive of cardiac events among patients with previous myocardial revascularisation, after controlling for clinical data.
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