Value of pharmacologic stress echocardiography in risk stratification of patients with single-vessel disease: a report from the echo-persantine and echo-dobutamine international cooperative studies

• Published in: Journal of the American College of Cardiology Vol. 32; no. 1; pp. 69 - 74
• Main Authors: Cortigiani, Lauro, Picano, Eugenio, Landi, Patrizia, Previtali, Mario, Pirelli, Salvatore, Bellotti, Paolo, Bigi, Riccardo, Magaia, Ornella, Galati, Alfonso, Nannini, Eugenio
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.1998; Elsevier Science
• Subjects: Biological and medical sciences; Cardiovascular system; Coronary Artery Bypass; Coronary Disease - diagnostic imaging; Coronary Disease - mortality; Coronary Disease - surgery; Dipyridamole; Dobutamine; Echocardiography - drug effects; Exercise Test; Follow-Up Studies; Humans; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - mortality; Myocardial Infarction - surgery; Prospective Studies; Risk Assessment; Sensitivity and Specificity; Survival Analysis; Sympathomimetics; Treatment Outcome; Ultrasonic investigative techniques; Vasodilator Agents; ECG; EPIC; EDIC; Sonography; Antianginal agent; Human; Pharmacologic test; Echocardiography; Prognosis; Single coronary artery; Dipyridamole; Instrumentation therapy; Dobutamine; Stenosis; Cardiovascular disease; Exploration; Coronary heart disease; Chemotherapy; Sensitivity; Specificity; Treatment; Surgery; Decision criterion; Predictive factor; Revascularization
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(98)00190-9

Objectives. This study sought to verify the effectiveness of pharmacologic stress echocardiography in risk stratification of patients with single-vessel disease. Background. Noninvasive prognostic assessment of single-vessel disease is an unresolved issue to date. Methods. The study evaluated prospectively collected data from 754 patients with angiographic single-vessel disease who underwent either dipyridamole (n = 576) or dobutamine (n = 178) stress echocardiography. Invasive treatment (coronary revascularization within 3 months of stress testing) was performed in 260 patients and medical treatment in 494. Results. Echocardiographic positivity was observed in 421 patients (56%). Patients treated invasively had a higher incidence of stress test positivity (69% vs. 49%, p < 0.001) and left anterior descending coronary artery involvement (60% vs. 46%, p < 0.001) than patients maintained with medical therapy. During a mean follow-up of 37 months, 54 hard cardiac events occurred (14 deaths, 40 nonfatal infarctions): 37 in medically and 17 in invasively treated patients (7.5% vs. 6.5%, p = NS). On Cox analysis, a positive result on stress testing was the only independent prognostic predictor in medically treated patients (relative risk 2.92, 95% confidence interval 1.29 to 6.59). The 4-year infarction-free survival rate was higher for a negative than a positive stress test result in medically (93.9% vs. 87.3%, p = 0.009) but not invasively treated patients (92.7% vs. 97.1%, p = 0.545). Moreover, a significantly higher 4-year infarction-free survival rate was found in invasively versus medically treated patients with a positive (p = 0.012), but not in those with a negative, stress test result (p = 0.853). Conclusions. Pharmacologic stress echocardiography is effective in risk stratification of single-vessel disease and can accurately discriminate patients in whom coronary revascularization can have the maximal beneficial effect. These findings have a potential favorable impact on the cost-effectiveness of invasive procedures.