Prognostic value of pharmacological stress echocardiography in patients with known or suspected coronary artery disease - A prospective, large-scale,multicenter, head-to-head comparison between dipyridamole and dobutamine test

OBJECTIVES The study compared the prognostic value of dipyridamole and dobu tamine stress echocardiography in patients with known or suspected coronary artery disease. BACKGROUND Extensive information is available on the relative diagnostic ac curacy of the mio tests assessed in a head-to-head fashion, whereas compara tive data on their prognostic yield are largely preliminary to date. METHODS Dipyridamole (up to 0.84 mg/kg over 10 min) atropine (up to 1 mg ov er 4 min) (DIP) and dobutamine (up to 40 mu g/kg/min)-atropine (1 mg over 4 min) (DOB) stress tests were performed in 460 patients with known or suspe cted coronary artery disease, Patients were followed up for 38 +/- 21 month s. RESULTS The DIP was negative in 253 and positive in 207 patients. The DOE w as negative in 242 and positive in 218 patients. During the follow-up, ther e were 80 cardiac events. For all cardiac events, the negative and positive predictive value were 83% and 17% for DOE, 84% and 19% for DIP, respective ly (p = NS). Considering only cardiac death, by univariate analysis Wall-Mo tion Score Index (WMSI) at DIP peak dose (chi-square 13.80, p < 0.0002) was the strongest predictor, followed by WMSI DOB (chi(2) = 8.02, p < 0.004) a nd WMSI at rest (chi(2) = 6.85, p < 0.008). By stepwise analysis, WMSI at D IP peak dose was the most important predictor (RR [relative risk] 7.4, p < 0.0001). CONCLUSIONS In patients at low-to-moderate risk of cardiac events, pharmaco logical stress echocardiography with either dobutamine or dipyridamole allo ws effective and grossly comparable, risk stratification on the basis of th e presence, severity and extension of the induced ischemia. (C) 1999 by the American College of Cardiology.