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Usefulness of Stress Echocardiography for Risk Stratification of Patients After Percutaneous Coronary Intervention

Cortigiani, Lauro, MD ; Sicari, Rosa, MD ; Bigi, Riccardo, MD ; Gherardi, Sonia, MD ; Rigo, Fausto, MD ; Gianfaldoni, Maria Luisa, MD ; Landi, Patrizia, BSc ; Bovenzi, Francesco, MD ; Picano, Eugenio, MD

The American journal of cardiology, 2008-11, Vol.102 (9), p.1170-1174 [Periódico revisado por pares]

New York, NY: Elsevier Inc

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Título:
Usefulness of Stress Echocardiography for Risk Stratification of Patients After Percutaneous Coronary Intervention
Autor: Cortigiani, Lauro, MD ; Sicari, Rosa, MD ; Bigi, Riccardo, MD ; Gherardi, Sonia, MD ; Rigo, Fausto, MD ; Gianfaldoni, Maria Luisa, MD ; Landi, Patrizia, BSc ; Bovenzi, Francesco, MD ; Picano, Eugenio, MD
Assuntos: Aged ; Angioplasty ; Angioplasty, Balloon, Coronary ; Biological and medical sciences ; Cardiology ; Cardiology. Vascular system ; Cardiotonic Agents - pharmacology ; Cardiovascular ; Cardiovascular disease ; Cardiovascular system ; Coronary Artery Disease - diagnostic imaging ; Coronary Artery Disease - mortality ; Dipyridamole - pharmacology ; Diseases of the cardiovascular system ; Dobutamine - pharmacology ; Echocardiography, Stress ; Female ; Humans ; Investigative techniques, diagnostic techniques (general aspects) ; Male ; Medical prognosis ; Medical sciences ; Middle Aged ; Myocardial Ischemia - chemically induced ; Patients ; Predictive Value of Tests ; Prognosis ; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) ; Risk Assessment ; Risk Factors ; Ultrasonic imaging ; Ultrasonic investigative techniques ; Vasodilator Agents - pharmacology
É parte de: The American journal of cardiology, 2008-11, Vol.102 (9), p.1170-1174
Descrição: The prognostic value of stress echocardiography in patients with previous percutaneous coronary intervention (PCI) remains undefined. The aim of this study was to investigate the prognostic implication of stress echocardiography after PCI. The study group comprised 1,063 patients (794 men, 65 ± 10 years of age) who underwent stress echocardiography with exercise (n = 105), dipyridamole (n = 780), or dobutamine (n = 178) after a median of 10 months from a successful PCI. Of these patients, 616 (58%) complained of chest pain and 447 (42%) were asymptomatic. Stress echocardiogram was positive for inducible ischemia in 328 patients (31%). During a median follow-up of 20 months, there were 167 events (61 deaths, 106 infarctions). Independent predictors of mortality were age (hazard ratio [HR] 1.06, 95% confidence interval [CI] 1.03 to 1.09, p <0.0001), wall motion score index at rest (HR 3.91, 95% CI 2.19 to 6.99, p <0.0001), and ischemia at stress echocardiography (HR 1.82, 95% CI 1.05 to 3.16, p = 0.03). Five-year mortalities were 20% in patients with and 9% in those without ischemia (p = 0.006). Independent predictors of hard events were ischemia at stress echocardiography (HR 3.82, 95% CI 2.75 to 5.29, p <0.0001), age (HR 1.02, 95% CI 1.01 to 1.04, p = 0.009), wall motion score index at rest (HR 1.98, 95% CI 1.30 to 3.02, p = 0.002), multivessel disease at time of PCI (HR 1.45, 95% CI 1.05 to 2.02, p = 0.02), and female gender (HR 1.44, 95% CI 1.03 to 2.01, p = 0.03). Five-year hard event rates were 53% in patients with and 16% in those without ischemia (p <0.0001). Stress echocardiographic positivity added prognostic information to clinical and at-rest echocardiographic parameters in symptomatic and asymptomatic patients. Moreover, it identified a subset of patients at higher risk of developing hard events independent of the subtending coronary anatomy (multivessel or single vessel disease). In conclusion, stress echocardiography is effective in risk-stratifying patients with previous PCI. In particular, inducible ischemia is a strong and independent predictor of mortality and hard events.
Editor: New York, NY: Elsevier Inc
Idioma: Inglês

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Usefulness of Stress Echocardiography for Risk Stratification of Patients After Percutaneous Coronary Intervention

Cortigiani, Lauro, MD ; Sicari, Rosa, MD ; Bigi, Riccardo, MD ; Gherardi, Sonia, MD ; Rigo, Fausto, MD ; Gianfaldoni, Maria Luisa, MD ; Landi, Patrizia, BSc ; Bovenzi, Francesco, MD ; Picano, Eugenio, MD

New York, NY: Elsevier Inc

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