Positive stress echocardiography was associated with an increased risk of MACE compared to negative stress echocardiography (annual event rate 1.99% vs 1.54%; OR 2.04, 95% CI 1.79 to 2.33).
Meta-Analysis (n=16,581)
Does a positive stress echocardiography result predict increased risk of MACE and mortality in patients with suspected coronary artery disease?
Positive stress echocardiography results are associated with a twofold increased risk of long-term MACE and all-cause mortality compared to negative results in patients with suspected coronary artery disease.
Effect estimate: OR 2.04 (95% CI 1.79 to 2.33)
Absolute Event Rate: 1.99% vs 1.54%
BACKGROUND: Long-term outcome of contemporary stress echocardiography has not been systematically assessed. OBJECTIVE: To evaluate the association between results of stress echocardiography and patients' outcomes with suspected coronary artery disease using randomised controlled trials. METHODS: Multiple electronic databases were searched for studies evaluating long-term outcome (>12 months) of stress echocardiography in patients suspected of coronary artery disease since year 2000. A common-effect model was used to derive pooled estimates. The primary outcome was a composite of all-cause mortality or cardiovascular death and non-fatal myocardial infarction, depending on the definition applied in individual trials, termed as major adverse cardiovascular event (MACE). Secondary outcome was all-cause mortality. Positive stress echocardiography result was defined as inducible ischaemia in at least one of the 17 left ventricular segments and negative stress echocardiography with no inducible ischaemia. RESULTS: Among a total of six trials, 16 581 subjects underwent either pharmacological or treadmill stress echocardiography, a median follow-up of 31 months (range 21-101). The annual event rate was 1.76% for the composite MACE and 1.35% for all-cause mortality. Compared with negative stress echocardiography, positive stress echocardiography was associated with an increased risk of the MACE and all-cause mortality with an annual event rate of 1.99% vs 1.54% (OR 2.04, 95% CI 1.79 to 2.33) and 1.68% vs 1.02% (OR 2.06, 95% CI 1.80 to 2.35), respectively. CONCLUSION: Positive stress echocardiography results were associated with poorer long-term MACE and all-cause mortality. Stress echocardiography results may provide a useful long-term guidance in intensifying preventative treatment in patients with suspected coronary artery disease. PROSPERO REGISTRATION NUMBER: CRD42023416766.
Ihekwaba et al. (Fri,) conducted a meta-analysis in suspected or known coronary artery disease (n=16,581). Positive stress echocardiography vs. Negative stress echocardiography was evaluated on composite of all-cause mortality or cardiovascular death and non-fatal myocardial infarction (MACE) (OR 2.04, 95% CI 1.79 to 2.33). Positive stress echocardiography was associated with an increased risk of MACE compared to negative stress echocardiography (annual event rate 1.99% vs 1.54%; OR 2.04, 95% CI 1.79 to 2.33).