Effect of coronary revascularization on the prognostic value of stress myocardial contrast wall motion and perfusion imaging

Background-The assessment of myocardial perfusion (MP) and wall motion (WM) using contrast dipyridamole echocardiography (cSE-WMP) improves the sensitivity to detect coronary artery disease and the stratification of cardiac events, but its long-term value for fatal and nonfatal ischemic cardiac events, also with respect to patients undergoing revascularization or not, remains to be determined. Methods and Results-One-thousand three-hundred and twenty-nine patients with suspect or known CAD who underwent cSEWMP were followed for a median 5.5 years. The independent prognostic value of cSE-WMP regarding cardiac death or nonfatal myocardial infarction was related to stress WM and MP, rest ejection fraction, clinical risk factors, and medications. Patients revascularized after cSE-WMP were separately analyzed to determine whether the procedure influenced outcome and whether this depends on cSE-WMP results. A total of 125 cardiac fatal and nonfatal ischemic events (9.4%) occurred during the follow-up (61 deaths, 64 myocardial infarctions). The 5-year event rate with normal MP and WM was 5.9%, 9.9% with isolated MP defects (normal WM), and 15.5% with both MP and WM abnormalities. In patients not undergoing revascularization (n = 1111), reversible MP defects added discrimination value over WM response and clinical factors/medication data (P = 0.001), while in the cohort undergoing revascularization (n = 218), cSE-WMP results did not influence outcome. Conclusions-cSE-WMP, with both contrast MP and WM assessments, provides independent, incremental prognostic information regarding ischemic cardiac events at 5 years in patients with known or suspected coronary artery disease. Revascularization reduces cardiac events after an abnormal cSE-WMP, resulting in outcomes not different from those in patients with normal cSE-WMP.