Independent and incremental value of stress echocardiography over clinical and stress electrocardiographic parameters for the prediction of hard cardiac events in new-onset suspected angina with no history of coronary artery disease

Accordingly, 547 consecutive patients (68+4.9 years) with chest pain but no previous history of CAD, referred for SE (exercise and dobutamine), were identified. Patients were followed up for death and acute myocardial infarction (AMI). At a median follow-up period of 28 months, there were a total of 35 hard cardiac events (5 deaths and 30 non- fatal AMI). Among the prognostic clinical, resting/stress ECG, and SE data, univariate predictors were the Framingham risk score (P ¼ 0.025), diabetes (P ¼ 0.06), hypercholesterolaemia (P ¼ 0.06), stress ECG ischaemia (P ¼ 0.044), stress heart rate (P ¼ 0.019), and SE-determined ischaemic burden (stress-rest wall thickening score index; P , 0.001). In a multivariate model, ischaemic burden was the only independent predictor of events (P , 0.001). SE also showed incremental prognostic value over and above clinical (Framingham's risk score) and stress ECG changes in a global x 2 model. This was true also for patients undergoing only exercise SE (n ¼ 347). Conclusion SE provides both independent and incremental prognostic value for the prediction of hard cardiac events in chest