Abstract 9440: Prognostic Value of Stress Echocardiography in Patients With Low (<10%)-Intermediate (10-20%) Framingham Risk Score (Short-Term) versus Low (<39%) or High (≥39%) Lifetime Predicted Risk of Cardiovascular Disease

Abstract

Background: The ideal risk assessment and management of patients with low-intermediate or high Framingham risk score (FRS, short-term) versus low or high lifetime cardiovascular (CV) risk is unclear. The purpose of this study was to evaluate the prognostic value of stress echocardiography (SE) in defined FRS and lifetime risk groups. Methods: We evaluated 4566 patients (60±13 years; 46% male) undergoing SE (41% treadmill, 59% dobutamine) with low-intermediate FRS (<20%) divided into: low (<39%, n=368) or high lifetime (≥39%, n=661) CV risk and third group with high FRS (≥20%, n=3537). Follow-up (3.2±1.5 years) for non-fatal myocardial infarction (n=102) and cardiac death (n=140) were obtained. Results: By univariate analysis, age (p<0.001), ejection fraction (p<0.001) and ≥3 ischemic wall motion abnormalities (WMA) (p<0.001) were significant predictors of cardiac events. Cumulative survival in patients with low or intermediate short term risk groups were significantly worse in patients with ≥3 WMA vs. <3 WMA in low-intermediate FRS and low (3.3%/year vs. 0.3%/year, p<0.001) or high lifetime CV risk (2.0%/year vs. 0%/year, p<0.001) and high FRS group (3.5%/year vs. 1.0%/year, p<0.001). Multivariate Cox proportional hazards analysis identified ≥3 new ischemic wall motion abnormalities as the strongest predictor of cardiac events (HR 3.2, 95% CI 2.2-4.6, p <0.001). Conclusion: Stress echocardiography results (absence or presence of ≥3 ischemic segments) can equally and effectively risk stratify low-intermediate or high FRS versus low or high lifetime cardiovascular risk patients. Event rate with normal SE is highest in patients with high FRS.