Cortigiani Lauro, Sicari Rosa, Bigi Riccardo, Gherardi Sonia, Rigo Fausto, Gianfaldoni Maria Luisa, Landi Patrizia, Bovenzi Francesco, Picano Eugenio
Division of Cardiology, Campo di Marte Hospital, Lucca, Italy.
Am J Cardiol. 2008 Nov 1;102(9):1170-4. doi: 10.1016/j.amjcard.2008.06.041. Epub 2008 Aug 15.
The prognostic value of stress echocardiography in patients with previous percutaneous coronary intervention (PCI) remains undefined. The aim of this study was to investigate the prognostic implication of stress echocardiography after PCI. The study group comprised 1,063 patients (794 men, 65 +/- 10 years of age) who underwent stress echocardiography with exercise (n = 105), dipyridamole (n = 780), or dobutamine (n = 178) after a median of 10 months from a successful PCI. Of these patients, 616 (58%) complained of chest pain and 447 (42%) were asymptomatic. Stress echocardiogram was positive for inducible ischemia in 328 patients (31%). During a median follow-up of 20 months, there were 167 events (61 deaths, 106 infarctions). Independent predictors of mortality were age (hazard ratio [HR] 1.06, 95% confidence interval [CI] 1.03 to 1.09, p <0.0001), wall motion score index at rest (HR 3.91, 95% CI 2.19 to 6.99, p <0.0001), and ischemia at stress echocardiography (HR 1.82, 95% CI 1.05 to 3.16, p = 0.03). Five-year mortalities were 20% in patients with and 9% in those without ischemia (p = 0.006). Independent predictors of hard events were ischemia at stress echocardiography (HR 3.82, 95% CI 2.75 to 5.29, p <0.0001), age (HR 1.02, 95% CI 1.01 to 1.04, p = 0.009), wall motion score index at rest (HR 1.98, 95% CI 1.30 to 3.02, p = 0.002), multivessel disease at time of PCI (HR 1.45, 95% CI 1.05 to 2.02, p = 0.02), and female gender (HR 1.44, 95% CI 1.03 to 2.01, p = 0.03). Five-year hard event rates were 53% in patients with and 16% in those without ischemia (p <0.0001). Stress echocardiographic positivity added prognostic information to clinical and at-rest echocardiographic parameters in symptomatic and asymptomatic patients. Moreover, it identified a subset of patients at higher risk of developing hard events independent of the subtending coronary anatomy (multivessel or single vessel disease). In conclusion, stress echocardiography is effective in risk-stratifying patients with previous PCI. In particular, inducible ischemia is a strong and independent predictor of mortality and hard events.
负荷超声心动图对既往接受经皮冠状动脉介入治疗（PCI）患者的预后价值尚不明确。本研究旨在探讨PCI术后负荷超声心动图的预后意义。研究组包括1063例患者（794例男性，年龄65±10岁），在成功PCI术后中位时间10个月后接受了运动负荷超声心动图检查（n = 105）、双嘧达莫负荷超声心动图检查（n = 780）或多巴酚丁胺负荷超声心动图检查（n = 178）。在这些患者中, 616例（58%）有胸痛症状，447例（42%）无症状。328例患者（31%）的负荷超声心动图显示有诱发性心肌缺血。在中位随访20个月期间，发生了167起事件（61例死亡，106例梗死）。死亡率的独立预测因素为年龄（风险比[HR] 1.06，95%置信区间[CI] 1.03至1.09，p <0.0001）、静息壁运动评分指数（HR 3.91，95%CI 2.19至6.99，p <0.0001）和负荷超声心动图检查时的心肌缺血（HR 1.82，95%CI 1.05至3.16，p = 0.03）。有心肌缺血患者的5年死亡率为20%，无心肌缺血患者为9%（p = 0.006）。严重事件的独立预测因素为负荷超声心动图检查时的心肌缺血（HR 3.82，95%CI 2.75至5.29，p <0.0001）、年龄（HR 1.02，95%CI 1.01至1.04，p = 0.009）、静息壁运动评分指数（HR 1.98，95%CI 1.对PCI时多支血管病变（HR 1.45，95%CI 1.05至2.02，p = 0.02）和女性（HR 1.44，95%CI 1.例患者的5年严重事件发生率为53%，无心肌缺血患者为16%（p <0.0001）。负荷超声心动图阳性结果为有症状和无症状患者的临床及静息超声心动图参数增加了预后信息。此外，它识别出了一组独立于相关冠状动脉解剖结构（多支血管或单支血管病变）而发生严重事件风险较高的患者。总之，负荷超声心动图对既往接受PCI的患者进行危险分层是有效的。特别是，诱发性心肌缺血是死亡率和严重事件的一个强有力的独立预测因素。
