Prognostic value of Dobutamine stress echocardiography in patients with previous percutaneous or surgical revascularization for coronary artery disease

Prognostic value of Dobutamine stress echocardiography (DSE) in patients (pts) with previous revascularization (tevasc) by either percutaneous coronary angioplasty (PTCA) or by coronary bypass graft surgery (CABG) has not been examined. We followed 1515 pts with DSE studies, mean age 55 ± 12 yra, 706 males, 809 females for a mean ± SD period of 18 ± 9 months for cardiac events including sudden death, myocardial infarction, unstable angina, revascularization, cardiac arrhythmias and congestive failure. Out of 383 pts with positive DSE for ischemia, 14 of 30 post PTCA pts (47%), 37 of 85 post CABG pts (44%), and 57 of 268 (21%) nonrevascularized (nonresvasc) pts had cardiac events (p<0.001 post PTCA and Post CABG compared to nonrevasc). In pts with negative DSE, 12 of 69 (17%) post PTCA pts and 8 of 47 (17%) post CABG pts had events compared to 47 of 1016 (4,6%) of pts without revasc. The overall sensitivity and specificity were 82%, 45% post CABG, 54%, 78% post PTCA and 55%, 82% in nonrevasc pts. To assess the prognostic value of DSE independent of coronary risk factors, LV dysfunction and previous myocardial infarction, multivariate Cox regression analysis was used. Positive DSE resulted in a risk ratio of 1.5 post PTCA and 2.1 post CABG when compared to nonrevasc pts The risk ratio of revasc pts with a negative DSE was 2.7 when compared to the nonrevasc group. The data indicate a higher sensitivity and a lower specificity of DSE in predicting future events in pts with previous CABG when compared to pts with previous PTCA and to pts without previous revascularization.