Prognostic value of dobutamine stress echocardiography in patients with previous coronary revascularisation

Objective: To assess the prognostic value of dobutamine stress echocardiography (DSE) in patients with previous myocardial revascularisation. Design: Prospective study. Setting: Tertiary referral centre in Rotterdam, the Netherlands. Patients: 332 consecutive patients with previous percutaneous or surgical coronary revascularisation underwent DSE. Follow up was successful for 331 (99.7%) patients. Thirty eight patients who underwent early revascularisation (less than or equal to 3 months) after the test were excluded from analysis. Main outcome measures: Cox proportional hazards regression models were used to identify independent predictors of the composite of cardiac events (cardiac death, non-fatal myocardial infarction, and late revascularisation). Results: During a mean (SD) of 24 (20) months, 37 (13%) patients died and 89 (30%) had at least one cardiac event (21 (7%) cardiac deaths, 11 (4%) non-fatal myocardial infarctions, and 68 (23%) late revascularisations). In multivariate analysis of clinical data, independent predictors of late cardiac events were hypertension (hazard ratio (HR) 1.7, 95% confidence interval (CI) 1.1 to 2.6) and congestive heart failure (HR 2.1, 95% CI 1.3 to 3.2). Reversible wall motion abnormalities (ischaemia) on DSE were incrementally predictive of cardiac events (HR 2.1, 95% CI 1.3 to 3.2). Conclusions: Myocardial ischaemia during DSE is independently predictive of cardiac events among patients with previous myocardial revascularisation, after controlling for clinical data.