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
dobutamine-atropine stress echocardiography (DSE) for prediction of late
cardiac events in patients with proven or suspected coronary artery
disease. METHODS AND RESULTS--Clinical data and DSE results were analyzed
in 1734 consecutive patients undergoing DSE between 1989 and 1997.
Seventy-four patients who underwent revascularization within 3 months of
DSE and 1 patient lost to follow-up were excluded; the remaining 1659
(median age, 62 years; range, 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-induced wall motion abnormalities (ischemia)
were scored for each patient. Cardiac events were related to clinical and
ECG data and DSE results. Four hundred twenty-eight cardiac events
occurred in 366, documented cardiac death in 108 (total death, 247),
nonfatal infarction in 128, and late revascularization in 192 patients. In
a multivariable Cox proportional-hazards model, the ratio of documented
cardiac death or (re)infarction was increased in the presence of
stress-induced ischemia (hazard ratio, 3.3; 95% CI, 2.4 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 cardiac
events. A normal DSE carried a relatively good prognosis, wit
