Contrast-Stress Echocardiography Predicts Coronary Syndromes

Exercise-electrocardiography not as useful among those with nondiagnostic EKG, normal troponins

WEDNESDAY, Jan. 26 (HealthDay News) -- Exercise-electrocardiogram testing may not accurately predict the risk of a cardiovascular event in patients with nondiagnostic electrocardiographic findings and normal 12-hour cardiac troponin levels, as compared to contrast-stress echocardiograms, according to a study published in the Jan. 15 issue of The American Journal of Cardiology.

Nicola Gaibazzi, M.D., from Parma University in Italy, and colleagues analyzed the one-year outcomes of 1,081 patients with complaints of chest pain with a suspected cardiac origin who presented to the emergency room in 2008. The patients did not have electrocardiographic abnormalities or troponin elevation. Within five days of admission, the patients each had a contrast-enhanced stress echocardiography with myocardial perfusion imaging or an exercise-electrocardiography. The results of these tests were classified as either normal, indeterminate, or abnormal.

The investigators found patients with normal results from the contrast-enhanced stress-echocardiographic findings had better event-free survival for cardiac death, nonfatal myocardial infarction, and acute coronary syndrome (log-rank P < 0.0001). Event-free survival for patients in the exercise-electrocardiographic group was not significantly different in any of the possible test result categories. While inducible ischemia detected by contrast-enhanced stress-echocardiography predicted the 1-year incidence of acute coronary syndrome (11.3 and 0.8 percent for positive and negative results, respectively), incidence of acute coronary syndrome was 2.7, 2.3, and 2.9 percent in patients with normal, indeterminate, and abnormal results by exercise-electrocardiography, respectively.

"Exercise-electrocardiography, typically performed in a lower risk population, did not prove useful for risk stratification. If these results are confirmed in randomized prospective studies, they could lead to a critical reappraisal of the current practice and recommendations for exercise-electrocardiography for chest pain unit patients," the authors write.

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