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Does ischemic burden on stress testing influence patient survival in subjects with known severe multi-vessel CAD?
Shey Mukundan1, Mark I Travin1, Jeffrey M Levsky1
1Montefiore Medical Center/Albert Einstein College of MedicineBronx, NY, USA.
Insights
For patients with severe coronary artery disease, stress test results showing ischemia do not impact long-term survival. This finding suggests focusing on other factors for prognosis in this population.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Clinical Prognosis
Background:
- Stress testing is used to assess prognosis in coronary artery disease (CAD).
- The prognostic value of stress test results in patients with severe, diffuse CAD is not well-established.
- Investigating the impact of stress test findings on long-term outcomes in this specific patient group is crucial.
Purpose of the Study:
- To determine the prognostic importance of stress test results in patients with severe multi-vessel coronary artery disease (CAD).
- To evaluate if stress test positivity influences long-term mortality in patients with diffuse atherosclerosis and preserved ventricular function.
Main Methods:
- Retrospective analysis of 139 patients with severe multi-vessel CAD undergoing nuclear stress tests (MPI) or stress echocardiograms (SE) between 2000-2005.
- Exclusion criteria included prior myocardial infarction, revascularization, or resting abnormalities.
- Mortality data were collected via the U.S. Social Security Index.
Main Results:
- 80% of stress tests were positive for ischemia.
- No significant difference in 1, 5, or 10-year mortality rates was observed between MPI and SE groups.
- Multivariate analysis confirmed that stress test positivity did not affect mortality at any time point.
Conclusions:
- In patients with severe, diffuse CAD and preserved ventricular function, the extent of ischemia on stress testing does not predict short or long-term survival.
- These findings suggest that stress test results may not be a primary prognostic factor in this high-risk population.
Background:
Ischemic burden observed during stress testing has been postulated to predict prognosis irrespective of anatomic atherosclerotic burden observed on angiography. However, it is not known if the stress test result influences the long-term prognosis of subjects with diffuse coronary artery disease. We sought to determine the prognostic importance of stress test false negativity amongst patients with severe multi-vessel coronary artery disease (CAD) undergoing stress testing in the previous decade.
Methods:
We selected subjects from the dates of 1/1/2000 to 12/31/2005 who underwent a nuclear stress test (MPI) or stress echocardiogram (SE) within six months of a coronary angiogram demonstrating severe, multi-vessel CAD. We excluded those with a prior MI, PCI, CABG, resting wall motion abnormality, or perfusion defect at rest. Determination of patient death during the followup period was performed using the U.S. social security index.
Results:
139 subjects (MPI 81, SE 58) were studied; stress tests were positive for ischemia in 80%. Rates of death were similar at 1 year (MPI 9%, SE 5%, p-value 0.44), 5 years (MPI 20%, SE 14%, p-value 0.36) and 10 years (MPI 30%, SE 26%, p-value 0.63). Using multivariate analysis, mortality at each time period was not affected by stress test positivity.
Conclusion:
Amongst subjects with diffuse and severe atherosclerosis with preserved ventricular function, ischemic burden on stress testing did not influence short or long-term survival.
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