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Prognostic Value Of Dobutamine Stress Echocardiography Reaffirmed
A DGReview of :"Prognostic value of predischarge dobutamine stress echocardiography in chest pain patients with a negative cardiac troponin T."
Journal of the American College of Cardiology (JACC)
03/04/2003
By Harvey McConnell
A pre-discharge dobutamine stress echocardiography (DSE) is an important prognostic tool among patients with chest pain and a negative cardiac troponin T, say Dutch researchers.
The study, carried out by investigators at the Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands, was undertaken because the prognostic value of immediate DSE has not been studied in a blinded, prospective fashion. At the same time, they note, non-invasive stress testing is recommended before discharge, or within 72 hours among patients with low-risk chest pain.
A total of 377 patients were enrolled after presenting at the emergency room within six hours after they first experienced symptoms. They had had either a normal or a non-diagnostic electrocardiogram (ECG). Clinicians decided to carry out a DSE when they diagnosed that the patients did not have unstable coronary artery disease by virtue of a standard rule-out protocol and a negative serial troponin T.
The clinicians considered as positive a finding of any new wall motion abnormality. Study end points were cardiac death, myocardial infarction, readmission to hospital for unstable angina or revascularization.
The end points occurred among 8 of 26 patients (30.8%) with a positive DSE, compared with 14 out of 351 patients (4.0%) patients with a negative DSE (odds ratio, 10.7). There were two deaths, two myocardial infarctions, eight readmission to hospital for unstable angina, and 10 revascularization at six-month follow-up.
It was concluded that DSE remained a predictor of end points, and it has and important, independent prognostic value in low-risk, troponin negative, chest pain patients.
J Am Coll Cardiol 2003 Feb;41:4:596-602.
"Prognostic value of predischarge dobutamine stress echocardiography in chest pain patients with a negative cardiac troponin T."
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