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Prognostic value of dobutamine stress echocardiography in patients with previous coronary revascularisation
  1. M Bountioukos1,
  2. A Elhendy1,
  3. R T van Domburg1,
  4. A F L Schinkel1,
  5. J J Bax2,
  6. B J Krenning1,
  7. E Biagini1,
  8. V Rizzello1,
  9. M L Simoons1,
  10. D Poldermans1
  1. 1Thoraxcentre, Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands
  2. 2Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
  1. Correspondence to:
    Dr Don Poldermans
    Thoraxcentre Room Ba 300, Department of Cardiology, Erasmus Medical Centre, Dr Molewaterplein 40, 3015 GD Rotterdam, the Netherlands;


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 (⩽ 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.

  • coronary revascularisation
  • dobutamine stress echocardiography

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