Which stress test is superior for perioperative cardiac risk stratification in patients undergoing major vascular surgery?

Objective: to compare the additional prognostic value of Dobutamine Stress Echocardiography (DSE), Dipyridamole Stress Echocardiography (DiSE) and Perfusion Scintigraphy (DTS) on clinical risk factors in patients undergoing major vascular surgery. Design: retrospective analysis. Materials: 2204 consecutive patients who underwent DSE (n = 1093), DiSE (n = 394), or DTS (n = 717) testing before major vascular surgery were studied. Methods: primary endpoint was a composite of cardiac death and non-fatal myocardial infarction (MI). Logistic regression analysis was performed to evaluate the relation between cardiac risk factors, stress test results and the incidence of the composite endpoint. Results: there were 138 patients (6.3%) with cardiac death or MI. Patients with 0, 1-2, and 3 or more risk factors experienced respectively 3.0, 5.7 and 17.4% cardiac events. We found no statistically significant difference in the predictive value of a positive test result for DiSE and DSE (Odds ratio (OR) of 37.1 [95% CI, 8.1-170.1] vs 9.6 [95% CI, 4.9-18.4]; p = 0.12), whereas a positive test result for DTS had significantly lower prognostic value (OR = 1.95 [95% CI, 1.2-3.2]). Conclusion: a result of stress echocardiography effectively stratified patients into low- and high-risk groups for cardiac complications, irrespective of clinical risk profile. In contrast, the prognostic value of DTS results was more likely to be dependent on patients' clinical risk profile.