Document Detail

Dipyridamole stress echocardiography stratifies outcomes of asymptomatic patients with recent myocardial revascularization.
MedLine Citation:
PMID:  18157613     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Patients with previous myocardial revascularization, even if symptom-free, remain at risk of subsequent cardiac events, so that a non-invasive tool able to stratify this population is wishful. OBJECTIVES: To assess the prognostic value of dipyridamole stress echocardiography (DipSE) in a population of asymptomatic patients following complete myocardial revascularization, either by coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). METHODS: We retrospectively evaluated 104 consecutive symptom-free patients (mean age 67+/-9.3 years, 75 males) with recent (<12 months) complete myocardial revascularization (48% PCI, 52% CABG) undergoing DipSE. Ischemia was defined as the onset of a new or worsening wall motion abnormality during DipSE. The composite end point of the study was cardiac death and non-fatal acute coronary syndrome. RESULTS: Myocardial ischemia was identified in 23 patients (22.1%). During a mean follow up of 21 months, 7 (30.4%) out of these patients suffered cardiac events. Among the remaining 81 patients (77.9%) with negative DipSE results, 7 (8.6%) experienced cardiac events. At multivariable analysis only a positive DipSE (odds ratio 3.9, P=0.03), wall motion score index at peak of stress (OR 3.6, P=0.04) and a prior myocardial infarction (odds ratio 3.5, P=0.04) achieved statistical significance for cardiac events. Moreover, DipSE effectively stratified patients into a high and low risk group according to presence of inducible ischemia (event rate per year 16% vs 4.8%, P=0.02). CONCLUSIONS: DipSE yields appropriate risk stratification and provides incremental prognostic value over clinical variables even in asymptomatic patients with prior complete myocardial revascularization. A negative DipSE portends a benign prognosis (<5% event rate/year) in such population.
Andrea Rossi; Tiziano Moccetti; Francesco Faletra; Paolo Cattaneo; Mariagrazia Rossi; Elena Pasotti; Cecilia Fantoni; Claudio Anzà; Massimo Baravelli
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Publication Detail:
Type:  Journal Article     Date:  2007-12-22
Journal Detail:
Title:  The international journal of cardiovascular imaging     Volume:  24     ISSN:  1569-5794     ISO Abbreviation:  Int J Cardiovasc Imaging     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-05-08     Completed Date:  2008-07-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100969716     Medline TA:  Int J Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  495-502     Citation Subset:  IM    
Department of Cardiology, Cardiocentro Ticino, Lugano, Switzerland.
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MeSH Terms
Acute Coronary Syndrome / etiology*,  mortality,  ultrasonography
Angioplasty, Transluminal, Percutaneous Coronary*
Coronary Angiography
Coronary Artery Bypass*
Coronary Artery Disease / complications,  mortality,  surgery,  therapy,  ultrasonography*
Dipyridamole / diagnostic use*
Echocardiography, Stress / methods*
Middle Aged
Myocardial Infarction / etiology*,  mortality,  ultrasonography
Odds Ratio
Retrospective Studies
Risk Assessment
Time Factors
Treatment Outcome
Vasodilator Agents / diagnostic use*
Reg. No./Substance:
0/Vasodilator Agents; 58-32-2/Dipyridamole

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