P332Stress echocardiography in older patients with suspected coronary ischaemia. Survival analysis study


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Abstract

Background and purpose: Prevalence rates of Coronary Heart Disease (CHD) increase with age, with around one in four men and one in five women aged 70 years and above living with CHD. Stress Echocardiography has high sensitivity and specificity for coronary ischaemia. In this study we assess the diagnostic impact of stress echocardiography including Dobutamine and treadmill stress tests in older patients in relation to their event free survival.Methods: A cohort of patients above the age of 70 years who had stress echocardiography was studied retrospectively. A combined end point was defined as cardiac death, non fatal myocardial infarction and hospital admission with acute coronary syndrome. Stress echocardiography results were coded as normal, one vessel, two vessel or three vessel disease based on the wall motion score index (WMSI). Survival curves were calculated by the Kaplan-Meier method. The log-rank test was carried out to determine significance of differences in survival times and to compare events occurring at all time points on the survival curves.Results: 509 cases were studied, 299 (59%) males and 210 (41%) females with mean age 77 years (70-93) and a median follow up period of 42 months. 406 (80%) patients had Dobutamine Stress Echocardiography and 101(20%) patients had Treadmill Stress Echocardiography. There was no evidence of inducible coronary ischaemia in 278 (54.7%) patients with median survival of 74 months. 169 (33.2%) patients had one vessel ischaemia with median survival of 71 months, 47 (9.2%) patients had two vessel ischaemia with median survival of 57 months and 15 (2.9%) patients had three vessel ischaemia with median survival of 44 months. Log Rank test showed the difference in survival times between the different outcome groups to be very significant.Conclusions: Stress echocardiography findings in older patients correlate well with the Event Free Survival Time. Findings suggestive of multiple vessel coronary ischaemia have worse survival time. This has great implications on risk stratification of older patients with suspected coronary ischaemia with more targeted use of coronary intervention.

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