title: Stress echocardiography for the risk stratification of patients following coronary bypass surgery.
abstract: OBJECTIVE
  The aim of the study was to assess the prognostic value of stress echocardiography after surgical revascularization.
  
  
  METHODS
  We evaluated 500 (100 women) patients who had undergone exercise or pharmacological SE after a median of 69 months after coronary artery by-pass grafting (CABG). Of these, 351 (70%) complained of symptoms suggestive of ischemic origin while 149 (30%) were tested for asymptomatic progression of the disease.
  
  
  RESULTS
  SE was positive for ischemia in 196 (39%) patients. During a median follow-up of 25 months, 61 patients died, 33 had a nonfatal myocardial infarction, and 112 underwent late (>3 months) revascularization. Multivariable Cox' regression analysis indicated age (HR=1.04; 95% CI 1.01-1.06; p<0.003), and peak WMSI (HR=3.07; 95% CI 1.96-4.81; p=0.0001) as independent predictors of hard (total mortality and myocardial infarction) events. SE information provided a significant improvement in predictive power of the statistical model (chi-square increase 34%, p<0.0001 for hard and 91%, p<0.0001 for major events, respectively). Survival analysis showed ischemia at SE to be associated with significantly higher hard and major event rate in both symptomatic and asymptomatic patients.
  
  
  CONCLUSIONS
  SE represents an effective tool for the risk stratification of patients with previous CABG independently of the presence of symptoms suggestive of ischemic origin.
authors.affiliation: Division of Cardiology, Campo di Marte Hospital, Lucca, Italy.
authors.forename: Lauro
authors.initials: L
authors.lastname: Cortigiani
authors.forename: Riccardo
authors.initials: R
authors.lastname: Bigi
authors.forename: Rosa
authors.initials: R
authors.lastname: Sicari
authors.forename: Patrizia
authors.initials: P
authors.lastname: Landi
authors.forename: Francesco
authors.initials: F
authors.lastname: Bovenzi
authors.forename: Eugenio
authors.initials: E
authors.lastname: Picano