Prognostic value of dobutamine stress echocardiography in patients with previous coronary revascularisation.

Abstract

To assess the prognostic value of dobutamine stress echocardiography (DSE) in patients with previous myocardial revascularisation. Prospective study. Tertiary referral centre in Rotterdam, the Netherlands. 332 consecutive patients with previous percutaneous or surgical coronary revascularisation underwent DSE. Follow up was successful for 331 (99.7%) patients. Thirty eight patients who underwent early revascularisation (<or= 3 months) after the test were excluded from analysis. Cox proportional hazards regression models were used to identify independent predictors of the composite of cardiac events (cardiac death, non-fatal myocardial infarction, and late revascularisation). During a mean (SD) of 24 (20) months, 37 (13%) patients died and 89 (30%) had at least one cardiac event (21 (7%) cardiac deaths, 11 (4%) non-fatal myocardial infarctions, and 68 (23%) late revascularisations). In multivariate analysis of clinical data, independent predictors of late cardiac events were hypertension (hazard ratio (HR) 1.7, 95% confidence interval (CI) 1.1 to 2.6) and congestive heart failure (HR 2.1, 95% CI 1.3 to 3.2). Reversible wall motion abnormalities (ischaemia) on DSE were incrementally predictive of cardiac events (HR 2.1, 95% CI 1.3 to 3.2). Myocardial ischaemia during DSE is independently predictive of cardiac events among patients with previous myocardial revascularisation, after controlling for clinical data.