Dipyridamole stress echocardiography stratifies outcomes of asymptomatic patients with recent myocardial revascularization.
Int J Cardiovasc Imaging
; 24(5): 495-502, 2008 Jun.
Article
em En
| MEDLINE
| ID: mdl-18157613
ABSTRACT
BACKGROUND:
Patients with previous myocardial revascularization, even if symptom-free, remain at risk of subsequent cardiac events, so that a non-invasive tool able to stratify this population is wishful.OBJECTIVES:
To assess the prognostic value of dipyridamole stress echocardiography (DipSE) in a population of asymptomatic patients following complete myocardial revascularization, either by coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI).METHODS:
We retrospectively evaluated 104 consecutive symptom-free patients (mean age 67+/-9.3 years, 75 males) with recent (<12 months) complete myocardial revascularization (48% PCI, 52% CABG) undergoing DipSE. Ischemia was defined as the onset of a new or worsening wall motion abnormality during DipSE. The composite end point of the study was cardiac death and non-fatal acute coronary syndrome.RESULTS:
Myocardial ischemia was identified in 23 patients (22.1%). During a mean follow up of 21 months, 7 (30.4%) out of these patients suffered cardiac events. Among the remaining 81 patients (77.9%) with negative DipSE results, 7 (8.6%) experienced cardiac events. At multivariable analysis only a positive DipSE (odds ratio 3.9, P=0.03), wall motion score index at peak of stress (OR 3.6, P=0.04) and a prior myocardial infarction (odds ratio 3.5, P=0.04) achieved statistical significance for cardiac events. Moreover, DipSE effectively stratified patients into a high and low risk group according to presence of inducible ischemia (event rate per year 16% vs 4.8%, P=0.02).CONCLUSIONS:
DipSE yields appropriate risk stratification and provides incremental prognostic value over clinical variables even in asymptomatic patients with prior complete myocardial revascularization. A negative DipSE portends a benign prognosis (<5% event rate/year) in such population.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Vasodilatadores
/
Doença da Artéria Coronariana
/
Angioplastia Coronária com Balão
/
Ponte de Artéria Coronária
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Ecocardiografia sob Estresse
/
Dipiridamol
/
Síndrome Coronariana Aguda
/
Infarto do Miocárdio
Tipo de estudo:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
Int J Cardiovasc Imaging
Assunto da revista:
DIAGNOSTICO POR IMAGEM
Ano de publicação:
2008
Tipo de documento:
Article
País de afiliação:
Suíça