Prognostic value of pharmacological stress echocardiography is affected by concomitant antiischemic therapy at the time of testing

Background - The aim of this study was to determine whether antianginal medications affect the prognostic value of pharmacological stress echocardiography. Methods and Results - From the EPIC - EDIC Data Bank, 7333 patients ( 5452 men; age; 59 +/- 10 years) underwent pharmacological stress echocardiography with either high-dose dipyridamole (0.84 mg/kg over 10 minutes; n = 4984) or high-dose dobutamine (up to 40 mug . kg(-1) . min(-1); n = 2349) (DET) for diagnostic purposes. At the time of testing, 1791 patients were on antiischemic therapy ( nitrates and/or calcium antagonists and/or beta-blockers). Patients were followed up for a mean of 2.6 years ( range, 1 to 206 months). DET was positive for myocardial ischemia in 2854 patients (39%) and negative in 4479 (61%). Total mortality was 336 (4.5%). Death was attributed to cardiac causes in 161 patients (2.1%). Survival was highest in patients with negative DET off therapy and lowest in patients with positive DET studied on therapy (95% versus 81%; P = 0.0000). Survival was comparable in patients with a negative test on therapy and in patients with a positive test off therapy (88% versus 84%, P = NS). Conclusions - Ongoing antiischemic therapy at the time of testing heavily modulates the prognostic value of pharmacological stress echo. In the presence of concomitant antiischemic therapy, a positive test is more prognostically malignant, and a negative test less prognostically benign.