Bholasingh Radha, Cornel Jan Hein, Kamp Otto, van Straalen Jan P, Sanders Gerard T, Tijssen Jan G P, Umans Victor A W M, Visser Cees A, de Winter Robbert J
Department of Cardiology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
J Am Coll Cardiol. 2003 Feb 19;41(4):596-602. doi: 10.1016/s0735-1097(02)02897-8.
We prospectively studied the prognostic value of predischarge dobutamine stress echocardiography (DSE) in low-risk chest pain patients with a normal or nondiagnostic electrocardiogram (ECG) and a negative serial troponin T.
Noninvasive stress testing is recommended before discharge or within 72 h in patients with low-risk chest pain. The prognostic value of immediate DSE has not been studied in a blinded, prospective fashion.
Patients presenting at the emergency room within 6 h of symptom onset and a normal or nondiagnostic ECG were eligible. Dobutamine stress echocardiography was performed after unstable coronary artery disease was ruled out by a standard rule-out protocol and a negative serial troponin T; the occurrence of any new wall motion abnormality was considered positive. Results were kept blinded. End points were cardiac death, myocardial infarction, rehospitalization for unstable angina or revascularization.
In total, 377 patients were included. There were 2 deaths, 2 myocardial infarctions, 8 rehospitalization for unstable angina, and 10 revascularizations at six-month follow-up. The end points occurred in 8/26 (30.8%) patients with a positive versus 14/351 (4.0%) patients with a negative DSE (odds ratio, 10.7; 95% confidence interval, 4.0 to 28.8; p < 0.0001). By multivariate analysis, DSE remained a predictor of end points (p < 0.0001).
A predischarge DSE had important, independent prognostic value in low-risk, troponin negative, chest pain patients.
我们前瞻性地研究了出院前多巴酚丁胺负荷超声心动图（DSE）对心电图（ECG）正常或无诊断意义且肌钙蛋白T连续检测为阴性的低危胸痛患者的预后价值。
对于低危胸痛患者，建议在出院前或72小时内进行无创负荷试验。即时DSE的预后价值尚未以盲法、前瞻性方式进行研究。
症状发作6小时内就诊于急诊室且ECG正常或无诊断意义的患者符合入选标准。通过标准排除方案和肌钙蛋白T连续检测为阴性排除不稳定型冠状动脉疾病后，进行多巴酚丁胺负荷超声心动图检查；出现任何新的室壁运动异常视为阳性。结果保持盲态。终点为心源性死亡、心肌梗死、因不稳定型心绞痛再次住院或血运重建。
共纳入377例患者。在六个月随访时，有2例死亡、2例心肌梗死、8例因不稳定型心绞痛再次住院以及10例血运重建。DSE阳性的患者中有8/26例（30.8%）出现终点事件，而DSE阴性的患者中有14/351例（4.0%）出现终点事件（优势比为10.7；95%置信区间为4.0至28.8；p<0.0001）。通过多变量分析，DSE仍然是终点事件的预测指标（p<0.0001）。
出院前DSE对低危、肌钙蛋白阴性的胸痛患者具有重要的独立预后价值。
