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.
OBJECTIVE
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.
Consiglio Nazionalle delle Ricerche Insitute of Clinical Physiology, Pisa, Italy.
L
L
Cortigiani
E
E
Picano
P
P
Landi
M
M
Previtali
S
S
Pirelli
P
P
Bellotti
R
R
Bigi
O
O
Magaia
A
A
Galati
E
E
Nannini
D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D004176:Dipyridamole; D004280:Dobutamine; D004452:Echocardiography / Q000187:drug effects; D005080:Exercise Test; D005500:Follow-Up Studies; D006801:Humans; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D013566:Sympathomimetics; D016896:Treatment Outcome; D014665:Vasodilator Agents
D013566:Sympathomimetics; D014665:Vasodilator Agents; D004280:Dobutamine; D004176:Dipyridamole