Key result
Positive exercise echocardiography alone was associated with more MACEs compared to positive ECG alone (HR 3.57; 95% CI 1.75-7.29; P<0.001), but fewer MACEs than positive ECG and Echo.
Why the study?
To evaluate comparative clinical outcomes of discordant exercise ECG and echocardiographic findings compared with concordant findings during treadmill exercise echocardiography in patients with chest pain and no history of CAD.
Does positive exercise echocardiography alone predict major adverse cardiac events better than positive exercise ECG alone in patients with chest pain and no history of coronary artery disease?
Cohort (n=1,725)
Does positive exercise echocardiography alone predict major adverse cardiac events better than positive exercise ECG alone in patients with chest pain and no history of coronary artery disease?
Hazard Ratio: 3.57 (95% CI 1.75–7.29)
p-value: p=< .001
Positive exercise echocardiography alone is a stronger predictor of major adverse cardiac events than positive exercise ECG alone in patients with chest pain and no prior coronary artery disease.
May refine MACE risk stratification beyond ECG alone in chest pain without CAD; hypothesis-generating and should not yet change practice.
The aim of this study was to evaluate comparative clinical outcomes of discordant electrocardiographic (ECG) and echocardiographic (Echo) findings compared with concordant findings during treadmill exercise echocardiography in patients with chest pain and no history of coronary artery disease (CAD).A total of 1725 consecutive patients who underwent treadmill echocardiography with chest pain and no history of CAD were screened. The patients were classified into 4 groups: ECG-/Echo- (negative ECG and Echo), ECG+/Echo- (positive ECG and negative Echo), ECG-/Echo+, and ECG+/Echo+. Concomitant CAD was determined using coronary angiography or coronary computed tomography. Major adverse cardiac events (MACEs) were defined as a composite of coronary revascularization, acute myocardial infarction, and death.MACEs were similar between ECG-/Echo- and ECG+/Echo- groups. Compared with ECG+/Echo- group, ECG-/Echo+ group had more MACEs (adjusted hazard ratio [HR] adjusted by clinical risk factors [95% confidence interval {CI}], 3.57 [1.75-7.29], P < .001). Compared with ECG+/Echo+ group, ECG-/Echo+ group had lower prevalence of concomitant CAD and fewer MACEs (HR, 0.49 [0.29-0.81], P = .006).Positive exercise Echo alone during treadmill exercise echocardiography had worse clinical outcomes than positive ECG alone, and the latter had similar outcomes to both negative ECG and Echo. Positive exercise Echo alone also had better clinical outcomes than both positive ECG and Echo. Therefore, exercise Echo findings might be superior for predicting clinical outcomes compared with exercise ECG findings. Additional consideration of ECG findings on positive exercise Echo will also facilitate better prediction of clinical outcomes.
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Hwang et al. (2019) conducted a cohort in Chest pain and no history of coronary artery disease (n=1,725). Positive exercise echocardiography alone (ECG-/Echo+) vs. Positive electrocardiography alone (ECG+/Echo-) was evaluated on Major adverse cardiac events (MACEs) defined as a composite of coronary revascularization, acute myocardial infarction, and death (HR 3.57, 95% CI 1.75-7.29, p=< .001). Positive exercise echocardiography alone was associated with more MACEs compared to positive ECG alone (HR 3.57; 95% CI 1.75-7.29; P<0.001), but fewer MACEs than positive ECG and Echo.
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