Prognostic value of pharmacological stress echocardiography in women with chest pain and unknown coronary artery disease

Objectives. In this study we sought to investigate the prognostic value of pharmacological stress echocardiography in women referred for chest pain, h aving unknown coronary artery disease. Background. The noninvasive identification of a high-risk subgroup among wo men with chest pain and unknown coronary artery disease is an unresolved ta sk to date. Methods. A total of 456 women (mean [+/-SD] age 63 +/- 10 years) underwent pharmacological stress echocardiography with either dipyridamole (n = 305) or dobutamine (n = 151) for evaluation of chest pain and mere followed-up f or 32 +/- 19 months. None of them had a previous diagnosis of coronary arte ry disease. Results. No major complication occurred during stress testing. Five tests ( 1.1%) were prematurely interrupted because of the appearance of side effect s. Echocardiographic positivity was identified in 51 patients. During the f ollow-up, 23 cardiac events occurred: 3 deaths, 10 infarctions and 10 cases of unstable angina; an additional 21 patients underwent coronary revascula rization. At Cox analysis, the echocardiographic evidence of ischemia was f ound as the only independent predictor of hard cardiac events (death, infar ction) (odds ratio [OR] = 27.5; 95% confidence interval [CI] = (6.5 to 115. 5; p = 0.0000). When spontaneous cardiac events (death, infarction and unst able angina) were considered as endpoints, the positive echocardiographic r esult (OR = 23.9; 95% CI = 8.6 to 66.8; p = 0.0000) and family history of c oronary artery disease (OR = 3.7; 95% CI = 1.5 to 9.1; p = 0.8037) were ind ependently correlated with prognosis. By using an interactive step,vise pro cedure, the prognostic value of stress echocardiography was found to he inc remental to that provided by clinical variables, both considering hard and spontaneous cardiac events as endpoints. The 3-year survival rate for the n egative and the positive population was respectively, 99.5% and 69.5% (p = 0.0000) considering hard cardiac events, 99.2% and 50.6% (p = 0.0000) consi dering spontaneous cardiac events. Conclusions. Pharmacological stress echocardiography is safe, highly feasib le and effective in risk stratification of women with chest pain and unknow n coronary artery disease, also when hard endpoints are considered. Its use can have relevant implications in daily clinical practice for selection of patients needing further investigations. (J Am Coil Cardiol 1998;32:1975-8 1) (C) 1998 by the American College of Cardiology.