Prognostic value of dobutamine stress echocardiography in patients with previous coronary revascularisation.
OBJECTIVE
To assess the prognostic value of dobutamine stress echocardiography (DSE) in patients with previous myocardial revascularisation.


METHODS
Prospective study.


METHODS
Tertiary referral centre in Rotterdam, the Netherlands.


METHODS
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 (<or= 3 months) after the test were excluded from analysis.


METHODS
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.
Thoraxcentre, Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
M
M
Bountioukos
A
A
Elhendy
R T
RT
van Domburg
A F L
AF
Schinkel
J J
JJ
Bax
B J
BJ
Krenning
E
E
Biagini
V
V
Rizzello
M L
ML
Simoons
D
D
Poldermans
D025401:Echocardiography, Stress / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology / Q000401:mortality; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000401:mortality; D009204:Myocardial Revascularization / Q000401:mortality*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate