Key result
In patients with multivessel CAD, stress-induced ischemia on echocardiography predicted a higher rate of adverse cardiac events compared to no ischemia (5.4% vs 1.9%/year; HR 5.5; 95% CI 1.9-15.9).
Why the study?
Does stress-induced ischemia on echocardiography predict adverse cardiac events in patients with multivessel coronary artery disease?
Cohort (n=409)
Does stress-induced ischemia on echocardiography predict adverse cardiac events in patients with multivessel coronary artery disease?
Hazard Ratio: 5.5 (95% CI 1.9–15.9)
Absolute Event Rate: 5.4% vs 1.9%
p-value: p=0.002
In patients with multivessel coronary artery disease, stress echocardiography provides significant incremental prognostic value over clinical variables and resting left ventricular function for predicting cardiac events.
May aid risk stratification in multivessel CAD; hypothesis-generating for ischemia-guided therapy trials.
OBJECTIVE: The purpose of this study was to evaluate the role of stress echocardiography in the risk stratification and prognosis of patients with multivessel coronary artery disease (CAD). BACKGROUND: Stress echocardiography is an established technique for diagnosis, risk stratification, and prognosis of patients with known or suspected CAD. METHODS: We evaluated 409 patients (65 ± 10 years; 63% men) referred for stress echocardiography (45% treadmill, 55% dobutamine), who underwent stress echocardiography and coronary angiography within 3 months. All patients had multivessel CAD as defined by coronary stenosis (≥50% left main or ≥70% in two or more major epicardial vessels or branches). The left ventricle was divided into 16 segments and was scored on a five-point scale of wall motion. Patients with abnormal results on stress echocardiography were defined as those with stress-induced ischemia (increase in wall motion score of ≥1 grade). RESULTS: Follow-up (3.1 ± 1.3 years) for nonfatal myocardial infarction (n = 35) and cardiac death (n = 25) was obtained. In patients with multivessel CAD, stress echocardiography effectively risk-stratified normal (no ischemia, n = 83) vs. abnormal (ischemia, n = 326) groups for cardiac events (event rate 1.9 vs. 5.4%/year; P < 0.01). Multivariable Cox proportional-hazards regression model identified stress-induced ischemia (hazard ratio 5.5, 95% confidence interval 1.9-15.9, P = 0.002) as the most significant predictor of adverse cardiac events. A stepwise Cox proportional-hazards model demonstrated significant incremental prognostic value of stress echocardiography over clinical variables, stress electrocardiography and resting left ventricular function (P < 0.0001), with the highest global chi-square value. CONCLUSIONS: In patients with angiographically significant multivessel CAD, despite normal-stress echocardiography, there was an intermediate cardiac event rate (1.9%/year); abnormal-stress echocardiography identified a high-risk group (5.4%/year); and stress echocardiography provided incremental prognostic value for risk stratification and prediction of cardiac events.
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Agarwal et al. (2015) conducted a cohort in Multivessel coronary artery disease (n=409). Abnormal stress echocardiography (stress-induced ischemia) vs. Normal stress echocardiography (no ischemia) was evaluated on Adverse cardiac events (nonfatal myocardial infarction and cardiac death) (HR 5.5, 95% CI 1.9-15.9, p=0.002). In patients with multivessel CAD, stress-induced ischemia on echocardiography predicted a higher rate of adverse cardiac events compared to no ischemia (5.4% vs 1.9%/year; HR 5.5; 95% CI 1.9-15.9).
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