title: Dipyridamole stress echocardiography stratifies outcomes of asymptomatic patients with recent myocardial revascularization.
abstract: BACKGROUND
  Patients with previous myocardial revascularization, even if symptom-free, remain at risk of subsequent cardiac events, so that a non-invasive tool able to stratify this population is wishful.
  
  
  OBJECTIVE
  To assess the prognostic value of dipyridamole stress echocardiography (DipSE) in a population of asymptomatic patients following complete myocardial revascularization, either by coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI).
  
  
  METHODS
  We retrospectively evaluated 104 consecutive symptom-free patients (mean age 67+/-9.3 years, 75 males) with recent (<12 months) complete myocardial revascularization (48% PCI, 52% CABG) undergoing DipSE. Ischemia was defined as the onset of a new or worsening wall motion abnormality during DipSE. The composite end point of the study was cardiac death and non-fatal acute coronary syndrome.
  
  
  RESULTS
  Myocardial ischemia was identified in 23 patients (22.1%). During a mean follow up of 21 months, 7 (30.4%) out of these patients suffered cardiac events. Among the remaining 81 patients (77.9%) with negative DipSE results, 7 (8.6%) experienced cardiac events. At multivariable analysis only a positive DipSE (odds ratio 3.9, P=0.03), wall motion score index at peak of stress (OR 3.6, P=0.04) and a prior myocardial infarction (odds ratio 3.5, P=0.04) achieved statistical significance for cardiac events. Moreover, DipSE effectively stratified patients into a high and low risk group according to presence of inducible ischemia (event rate per year 16% vs 4.8%, P=0.02).
  
  
  CONCLUSIONS
  DipSE yields appropriate risk stratification and provides incremental prognostic value over clinical variables even in asymptomatic patients with prior complete myocardial revascularization. A negative DipSE portends a benign prognosis (<5% event rate/year) in such population.
authors.affiliation: Department of Cardiology, Cardiocentro Ticino, Lugano, Switzerland.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rossi
authors.forename: Tiziano
authors.initials: T
authors.lastname: Moccetti
authors.forename: Francesco
authors.initials: F
authors.lastname: Faletra
authors.forename: Paolo
authors.initials: P
authors.lastname: Cattaneo
authors.forename: Mariagrazia
authors.initials: M
authors.lastname: Rossi
authors.forename: Elena
authors.initials: E
authors.lastname: Pasotti
authors.forename: Cecilia
authors.initials: C
authors.lastname: Fantoni
authors.forename: Claudio
authors.initials: C
authors.lastname: Anzà
authors.forename: Massimo
authors.initials: M
authors.lastname: Baravelli
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery / Q000628:therapy; D004176:Dipyridamole; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D014665:Vasodilator Agents
chemical_list: D014665:Vasodilator Agents; D004176:Dipyridamole