Stress Echocardiography in Known or Suspected Coronary Artery Disease

Flachskampf, Frank A.; Rost, Christian

doi:10.1016/j.jacc.2009.02.033

Cited by 2 publications

(1 citation statement)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In these patients, the change in wall motion score index was an independent predictor of mortality, which yielded incremental value over the clinical, resting echocardiographic and exercise hemodynamic data. Conversely, an accompanying editorial emphasized that a normal exercise echocardiogram predicted an annual cardiac death or infarction rate of only 0.84% and 0.64% (103).…”

Section: Echocardiographymentioning

confidence: 99%

Highlights of the Year in JACC2009

DeMaria

Bax

Ben‐Yehuda

et al. 2010

Journal of the American College of Cardiology

View full text Add to dashboard Cite

Long-term outcomes. A patient-level, pooled analysis of 4 randomized sirolimus-eluting stent (SES) trials (1) in 1,748 patients assigned to receive either an SES or bare-metal stent (BMS) showed a continued benefit of SES on target vessel revascularization (TVR) (15.2% vs. 30.1%; p Ͻ 0.0001) without differences in 5-year rate of death, myocardial infarction (MI), the composite of death/MI, or stent thrombosis (ST). The annualized rates of definite/probable ST after 1 year were 0.4% for SES and 0.2% for BMS. SES compared with BMS demonstrated superior 5-year reduction of TVR without an increase in rates of death, MI, or ST. DES in ST-segment elevation myocardial infarction (STEMI). A meta-analysis identified 13 randomized trials (n ϭ 7,352) comparing BMS versus DES in STEMI (2). Over a 2-year follow-up, DES significantly reduced TVR (relative risk [RR]: 0.44), without increasing MI or ST. Similarly, in 18 registry studies (n ϭ 26,521), DES significantly reduced TVR (RR: 0.54; 95% confidence interval) without an increase in MI. Death was significantly lower with DES within 1 year of the index percutaneous coronary intervention (PCI), but there were no differences within 2 years. The use of DES appears safe and efficacious in patients with STEMI. DES in saphenous vein grafts (SVGs).Eighty patients with 112 lesions in 88 SVGs were randomized to a BMS or paclitaxel-eluting stent (PES) (3). Binary angiographic restenosis occurred in 51% of the BMS-treated lesions versus 9% of the PES-treated lesions. During a median follow-up of 1.5 years, the PES patients had less target lesion revascularization (TLR) (28% vs. 5%) and target vessel failure (46% vs. 22%), and a trend toward less TVR (31% vs. 15%). In SVG lesions, PES are associated with lower rates of angiographic restenosis and target vessel failure than BMS. Coronary artery disease. A total of 130 patients with significant proximal left anterior descending coronary artery (LAD) coronary artery disease were randomized to either SES (n ϭ 65) or minimally invasive direct coronary artery bypass (MIDCAB) surgery (n ϭ 65) (4). Major adverse cardiac events (MACE) at 12 months occurred in 7.7% of SES patients versus 7.7% after MIDCAB (p ϭ 0.03 for noninferiority). Although noninferiority was observed in death and MI, noninferiority was not established for the difference in TVR (6.2% vs. 0%, noninferiority p ϭ 0.21). Clinical symptoms improved significantly in both treatment groups. In isolated proximal LAD disease, SES is noninferior to MIDCAB surgery at 12-month follow-up with respect to MACE at a similar relief in clinical symptoms. Coronary vasoconstriction. Coronary endothelial dysfunction was evaluated in a randomized fashion at 6 months following LAD implantation of zotarolimus-eluting stent (ZES) (n ϭ 20), SES (n ϭ 20), and BMS (n ϭ 10) (5). Incremental intracoronary acetylcholine (Ach) and nitrate infusions were given and coronary diameter evaluated in the 5-mm segments proximal and distal to the stent. In the DES groups, more intense vasoconstriction was observed at...

show abstract

Section: Echocardiographymentioning

confidence: 99%