Long-term prognostic value of dobutamine-atropine stress echocardiography in 1737 patients with known or suspected coronary artery disease - A single-center experience

Background-The purpose of this study was to assess the long-term value of d obutamine-atropine stress echocardiography (DSE) for prediction of late car diac events in patients with proven or suspected coronary artery disease. Methods and Results-Clinical data and DSE results were analyzed in 1734 con secutive patients undergoing DSE between 1989 and 1997. Seventy-four patien ts who underwent revascularization within 3 months of DSE and 1 patient los t to follow-up were excluded; the remaining 1659 (median age, 62 years; ran ge, 14 to 99 years) were followed up for 36 months (range, 6 to 96 months). Wall motion abnormalities at rest and the presence and extent of stress-in duced wall motion abnormalities (ischemia) were scored for each patient. Ca rdiac events were related to clinical and ECG data and DSE results. Four hu ndred twenty-eight cardiac events occurred in 366, documented cardiac death in 108 (total death, 247), nonfatal infarction in 128, and late revascular ization in 192 patients. In a multivariable Cox proportional-hazards model, the ratio of documented cardiac death or (re)infarction was increased in t he presence of stress-induced ischemia (hazard ratio, 3.3; 95% CI, 3.4 to 4 .4) and extensive rest wall motion abnormalities (hazard ratio, 1.9; 95% CI , 1.3 to 2.6). The number of ischemic segments was predictive for late card iac events. A normal DSE carried a relatively good prognosis, with an annua l event rate of cardiac death or infarction of 1.3% over a 5-year period. Conclusions-In a large group of patients, DSE has an added value for predic ting late cardiac events during long-term follow-up, improving the separati on between high- risk and very-low-risk patients.