Key result
A discordant result of normal stress echocardiography but positive stress ECG did not significantly increase the risk of major adverse cardiovascular events compared to concordant normal results (OR 2.02).
Why the study?
Physicians face a clinical dilemma when stress ECG and stress echocardiography results are discordant, such as negative stress echocardiography with positive stress ECG.
Does a discordant positive stress ECG with a normal stress echocardiogram increase the risk of MACE compared to concordant negative results in patients with suspected coronary artery disease?
Observational (n=901)
No
Does a discordant positive stress ECG with a normal stress echocardiogram increase the risk of MACE compared to concordant negative results in patients with suspected coronary artery disease?
In patients with suspected coronary artery disease, a discordant positive stress ECG with a normal stress echocardiogram does not confer a higher risk of MACE compared to concordant negative results.
May support conservative management of discordant stress results; leaves open prospective validation in suspected CAD.
INTRODUCTION: During stress echocardiography, the echocardiologist routinely collects both echocardiographic images and stress electrocardiogram (ECG) concurrently. The managing physician faces a dilemma when the stress ECG and stress echocardiography results are discordant; for example, when a patient has negative stress echocardiography but positive stress ECG. We therefore sought to evaluate the prognostic value of stress echocardiography in relation to concordant or discordant stress ECG findings in our local Singapore setting, which has a well-defined Southeast Asian population. METHODS: This was a retrospective observational study of all patients who underwent stress echocardiography in 2012 at Changi General Hospital, Singapore. All study patients were followed up for 18 months via electronic medical records. RESULTS: There was no difference in the major adverse cardiovascular events (MACE) outcome of patients with normal stress echocardiography and normal stress ECG (reference group) as compared with patients with normal stress echocardiography but positive (discordant) stress ECG (odds ratio 2.02, 95% confidence interval 0.82‒4.98; p = 0.125). CONCLUSION: This study will help to reassure cardiologists that discordant results (negative stress echocardiography but positive stress ECG) do not portend a higher risk of MACE when compared to concordant results (i.e. both stress echocardiography and stress ECG are negative).
No takes yet. Share an insight, caveat, or question.
Chai et al. (2019) conducted an observational in Suspected coronary artery disease (n=901). Discordant stress ECG (normal stress echocardiography but positive stress ECG) vs. Concordant normal results (normal stress echocardiography and normal stress ECG) was evaluated on Major adverse cardiovascular events (MACE) (OR 2.02, 95% CI 0.82-4.98, p=0.125). A discordant result of normal stress echocardiography but positive stress ECG did not significantly increase the risk of major adverse cardiovascular events compared to concordant normal results (OR 2.02).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: