Prognostic significance of ST-segment elevation during dobutamine stress echocardiography.
BACKGROUND
Limited data are available concerning the significance of ST-segment elevation during dobutamine stress echocardiography (DSE). The purpose of this study was to assess the prognostic significance of new ST-segment elevation during DSE and its relationship to angiographic severity of coronary artery disease (CAD).


METHODS
From 4240 consecutive patients who had DSE, we identified 134 (3%) patients with new stress-induced ST-segment elevation > or =1 mm in at least two contiguous electrocardiographic leads. Significant CAD was considered as > or =50% diameter obstruction by angiography. Follow-up was obtained for cardiac events.


RESULTS
Age was 69 +/- 10 years; 84 (63%) were men. ST-segment elevation developed in the anterior leads in 55 (41%), inferior leads in 100 (75%), and lateral leads in 54 (40%); 56 (42%) had ST elevation in more than one region. Dobutamine stress echocardiography was abnormal in all patients; 115 (86%) had ischemia. Coronary angiography was obtained in 69 (51%) patients. Stenosis was > or =70% diameter in 68 (99%) patients and multivessel in 53 (77%). Follow-up (2.6 +/- 2.8 years) was obtained in all 134 patients. Events occurred in 103 (77%) patients, including death in 53, coronary revascularization in 33, myocardial infarction in 12, and unstable angina in 5. Event-free survival was 55% at 2 years, 38% at 4 years, and 28% at 5 years.


CONCLUSIONS
Patients with stress-induced ST-segment elevation during DSE commonly have severe CAD and are at high risk for events during follow-up. These patients should be considered for coronary angiography.
Arruda
Ana Lucia M
AL
Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, MN, USA.
Barretto
Rodrigo B M
RB
Shub
Clarence
C
Chandrasekaran
Krishnaswamy
K
Pellikka
Patricia A
PA
D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging; D025401:Echocardiography, Stress; D004562:Electrocardiography; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies