Abstract 135: Clinical Decision Making Utility of Stress Echocardiography in Contemporary Managed Patients with Suspected Coronary Artery Disease

Abstract

Background: We have investigated outcomes of contemporary management in patients undergoing stress echocardiography for evaluation of chest pain. Methods: Records of 294 consecutive patients who underwent a stress echocardiogram at a single tertiary care center were reviewed. Demographic, clinical data, and outcomes were collected. ANOVA, chi-square, and logistic regression analyses were used. Mean follow up length was 37 months. The study was approved by the IRB. Results: This study cohort included 46% women, with an average age of 61 +/- 10.6 years old; 20% were current smokers, with history of CAD in 26%, CHF in 4%, hypertension in 40%, diabetes in 14%, and peripheral vascular disease in 4%. Baseline medical treatment included beta blockers in 46% and ACE inhibitors in 24%. The majority (94%) of these patients underwent a dobutamine stress echocardiogram. Fifty five of the 294 patients had ischemia during the test. Males were twice as likely to have ischemia during the stress test compared to females (24% vs. 12% p=0.009). There was a trend towards increased prevalence of ischemia in diabetics (26% vs. 17% p=0.175) and in smokers (24% vs. 17% p=0.262). The presence of ischemia was associated with a 40% increase in mortality (14.5% vs. 10.5%) and an approximately 3-fold increase in MI (9.1% vs. 2.9% p=0.0679). Patients with ischemia during stress testing were ten times more likely to have invasive cardiac evaluation and changes in medications compared to patients without ischemia during stress testing (41.5% vs. 4.1% p<0.001) or undergo invasive evaluation without a change in medications (24.5% vs. 3.3% p<0.001). Invasive evaluation was not associated with a reduction in mortality (13.4% vs. 10.4% p=0.349). However, change in medications alone was associated with increased mortality (16.7% vs. 9.7% p=0.04). Conclusions: In the majority of contemporary managed patients with suspected coronary artery disease, stress testing is likely to have a normal result. When abnormal, it typically leads to invasive evaluation and/or medication changes. The small sample size of patients with ischemia in our study limits our ability to discern the effects of invasive evaluation and/or medicine changes on outcomes. Additional studies of this important subject are needed.