A positive stress echocardiogram in real-world practice was associated with a greater risk of cardiac-related mortality and myocardial infarction (HR 2.03; 95% CI 1.41-2.93; P<0.001).
Cohort (n=5,503)
Yes
Does a positive stress echocardiogram predict long-term cardiovascular outcomes in patients with chest pain compared to a negative test?
In real-world practice, stress echocardiography results effectively stratify the 5-year risk of future cardiovascular events, with a negative test providing a 4-5 year 'warranty period'.
Effect estimate: HR 2.03 (95% CI 1.41-2.93)
p-value: p=< 0.001
AIMS: Stress echocardiography is widely used to assess patients with chest pain. The clinical value of a positive or negative test result to inform on likely longer-term outcomes when applied in real-world practice across a healthcare system has not been previously reported. METHODS AND RESULTS: Five thousand five hundred and three patients recruited across 32 UK NHS hospitals between 2018 and 2022, participating in the EVAREST/BSE-NSTEP prospective cohort study, with data on medical outcomes up to 2023 available from NHS England were included in the analysis. Stress echocardiography results were related to outcomes, including death, procedures, hospital admissions, and relevant cardiovascular diagnoses, based on Kaplan-Meier analysis and Cox proportional hazard ratios (HRs). Median follow-up was 829 days (interquartile range 224-1434). A positive stress echocardiogram was associated with a greater risk of myocardial infarction HR 2.71, 95% confidence interval (CI) 1.73-4.24, P < 0.001 and a composite endpoint of cardiac-related mortality and myocardial infarction (HR 2.03, 95% CI 1.41-2.93, P < 0.001). Hazard ratios increased with ischaemic burden. A negative stress echocardiogram identified an event-free 'warranty period' of at least 5 years in patients with no prior history of coronary artery disease and 4 years for those with disease. CONCLUSION: In real-world practice, the degree of myocardial ischaemia recorded by clinicians at stress echocardiography correctly categorizes risk of future events over the next 5 years. Reporting a stress echocardiogram as negative correctly identifies patients with no greater than a background risk of cardiovascular events over a similar time period.
Woodward et al. (Tue,) conducted a cohort in Chest pain (n=5,503). Positive stress echocardiogram vs. Negative stress echocardiogram was evaluated on Composite endpoint of cardiac-related mortality and myocardial infarction (HR 2.03, 95% CI 1.41-2.93, p=< 0.001). A positive stress echocardiogram in real-world practice was associated with a greater risk of cardiac-related mortality and myocardial infarction (HR 2.03; 95% CI 1.41-2.93; P<0.001).