Concomitant antiischemic therapy during pharmacological stress echocardiography modulates its prognostic value, with survival ranging from 95% (negative test off therapy) to 81% (positive test on therapy; P=0.0000).
Cohort (n=7,333)
Does concomitant antiischemic therapy affect the prognostic value of pharmacological stress echocardiography in patients undergoing diagnostic testing?
Concomitant antiischemic therapy during pharmacological stress echocardiography significantly alters its prognostic value, making a positive test more malignant and a negative test less benign.
Absolute Event Rate: 81% vs 95%
p-value: p=0.0000
BACKGROUND: The aim of this study was to determine whether antianginal medications affect the prognostic value of pharmacological stress echocardiography. METHODS AND RESULTS: From the EPIC-EDIC Data Bank, 7333 patients (5452 men; age; 59+/-10 years) underwent pharmacological stress echocardiography with either high-dose dipyridamole (0.84 mg/kg over 10 minutes; n=4984) or high-dose dobutamine (up to 40 microg x kg(-1) x min(-1); n=2349) (DET) for diagnostic purposes. At the time of testing, 1791 patients were on antiischemic therapy (nitrates and/or calcium antagonists and/or beta-blockers). Patients were followed up for a mean of 2.6 years (range, 1 to 206 months). DET was positive for myocardial ischemia in 2854 patients (39%) and negative in 4479 (61%). Total mortality was 336 (4.5%). Death was attributed to cardiac causes in 161 patients (2.1%). Survival was highest in patients with negative DET off therapy and lowest in patients with positive DET studied on therapy (95% versus 81%; P=0.0000). Survival was comparable in patients with a negative test on therapy and in patients with a positive test off therapy (88% versus 84%, P=NS). CONCLUSIONS: Ongoing antiischemic therapy at the time of testing heavily modulates the prognostic value of pharmacological stress echo. In the presence of concomitant antiischemic therapy, a positive test is more prognostically malignant, and a negative test less prognostically benign.
Sicari et al. (2004) conducted a cohort in Patients undergoing pharmacological stress echocardiography (n=7,333). Concomitant antiischemic therapy vs. No antiischemic therapy was evaluated on Survival (p=0.0000). Concomitant antiischemic therapy during pharmacological stress echocardiography modulates its prognostic value, with survival ranging from 95% (negative test off therapy) to 81% (positive test on therapy; P=0.0000).