Key result
Early coronary revascularization after an ischemic dobutamine stress echocardiogram was associated with reduced all-cause mortality over a median of 10 years.
Why the study?
Does early coronary revascularization improve long-term survival in patients with myocardial ischemia on dobutamine stress echocardiography?
Cohort (n=905)
Does early coronary revascularization improve long-term survival in patients with myocardial ischemia on dobutamine stress echocardiography?
Answers are grounded in this paper and cite their sources.
Early coronary revascularization is associated with significantly lower long-term all-cause and cardiac mortality in patients demonstrating either mild-to-moderate or marked ischemia on dobutamine stress echocardiography.
The role of early coronary revascularization in the management of stable coronary artery disease remains controversial. The aim of this study was to evaluate the impact of early coronary revascularization on long-term outcomes (>10 years) after an ischemic dobutamine stress echocardiography (DSE) in patients with known or suspected coronary artery disease. Patients without stress-induced ischemia on DSE and those who underwent late coronary revascularization (>90 days after DSE) were excluded. The final study cohort consisted of 905 patients. A DSE with a peak wall motion score index of 1.1 to 1.7 was considered mild to moderately abnormal (n = 460), and >1.7 was markedly abnormal (n = 445). End points were all-cause and cardiac mortality. The impact of early coronary revascularization on outcomes was assessed using Kaplan-Meier survival analysis and Cox's proportional hazard regression models. Early coronary revascularization was performed in 222 patients (percutaneous coronary intervention in 113 [51%] and coronary artery bypass grafting in 109 patients [49%]). During a median follow-up time of 10 years (range 8 to 15), 474 deaths (52%) occurred, of which were 241 (51%) due to cardiac causes. Kaplan-Meier survival curves showed that both in patients with a markedly abnormal DSE and a mild-to-moderately abnormal DSE, early revascularization was associated with better long-term outcomes. Multivariable analyses revealed that early revascularization had a beneficial effect on all-cause mortality (hazard ratio 0.60, 95% confidence interval 0.46 to 0.79) and cardiac mortality (hazard ratio 0.49, 95% confidence interval 0.34 to 0.72). In conclusion, early coronary revascularization has a beneficial impact on long-term outcomes in patients with myocardial ischemia on DSE. Early coronary revascularization was associated with better outcomes not only in patients with a markedly abnormal DSE but also in those with a mild to moderately abnormal DSE.
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Boiten et al. (2016) conducted a cohort in Known or suspected coronary artery disease with myocardial ischemia (n=905). Early coronary revascularization vs. No early coronary revascularization was evaluated on All-cause mortality (HR 0.60, 95% CI 0.46 to 0.79). Early coronary revascularization after an ischemic dobutamine stress echocardiogram was associated with reduced all-cause mortality over a median of 10 years.
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