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Usefulness of stress echocardiography for risk stratification of patients after percutaneous coronary intervention

Lauro Cortigiani1, Rosa Sicari, Riccardo Bigi

  • 1Division of Cardiology, Campo di Marte Hospital, Lucca, Italy.

The American Journal of Cardiology
|October 23, 2008
PubMed

Insights

Stress echocardiography effectively predicts outcomes in patients post-percutaneous coronary intervention (PCI). Inducible ischemia detected during stress testing is a strong indicator of mortality and adverse cardiac events, aiding in risk stratification.

Area of Science:

  • Cardiology
  • Diagnostic Imaging
  • Preventive Medicine

Background:

  • The prognostic value of stress echocardiography following percutaneous coronary intervention (PCI) is not well-established.
  • Accurate risk stratification is crucial for managing patients after PCI to predict future cardiac events.

Purpose of the Study:

  • To evaluate the prognostic implications of stress echocardiography in patients who have previously undergone PCI.
  • To determine if stress echocardiography provides additional prognostic information beyond clinical and resting echocardiographic parameters.

Main Methods:

  • A cohort of 1,063 patients with prior successful PCI underwent stress echocardiography (exercise, dipyridamole, or dobutamine).
  • Patients were followed for a median of 20 months to record mortality and myocardial infarction events.
  • Statistical analysis identified independent predictors of mortality and hard cardiac events.

Main Results:

  • Stress echocardiography positivity for inducible ischemia was observed in 31% of patients.
  • Inducible ischemia was an independent predictor of both mortality (HR 1.82) and hard events (HR 3.82).
  • Five-year mortality was significantly higher in patients with ischemia (20%) compared to those without (9%).
  • Five-year hard event rates were substantially higher in patients with ischemia (53%) versus without (16%).

Conclusions:

  • Stress echocardiography is effective in risk-stratifying patients after PCI, identifying those at higher risk for adverse outcomes.
  • Inducible ischemia detected by stress echocardiography is a strong, independent predictor of mortality and hard cardiac events.
  • The findings support the use of stress echocardiography to refine risk assessment in both symptomatic and asymptomatic patients post-PCI.

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