Characteristics and Outcomes of Patients With Abnormal Stress Echocardiograms and Angiographically Mild Coronary Artery Disease (<50% Stenoses) or Normal Coronary Arteries

Background: Abnormal cardiac stress imaging findings are not always associated with angiographically significant coronary artery disease. The outcomes of patients with such false-positive findings have not been extensively examined. The aim of this retrospective study was to describe the characteristics and outcomes of patients with abnormal stress echocardiographic findings who had false-positive results compared with those who had true-positive results. Methods: Of 1,477 consecutive patients (mean age, 66 ± 12 years; 61% men) with abnormal stress echocardiographic findings who underwent coronary arteriography within 30 days, death from any cause was ascertained. Results: At coronary arteriography, 997 patients (67.5%) had true-positive results, defined by the presence of angiographically significant coronary artery disease (≥50% stenoses), and 480 (32.5%) had false-positive results, defined by <50% stenoses or normal coronary arteries. Of the subgroup of patients with markedly abnormal stress echocardiographic findings (n = 605), 28% had <50% stenoses or normal coronary arteries. During an average follow-up period of 2.4 ± 1.0 years, there were 140 deaths. The adjusted likelihood of subsequent death for patients with <50% stenoses compared to patients with ≥50% stenoses after abnormal stress echocardiography was 1.05 (95% confidence interval, 0.86-1.31; P = .62). Conclusions: A sizable proportion of patients with abnormal stress echocardiographic results who are referred for coronary angiography have false-positive findings. The outcomes of patients with false-positive results were similar to those of patients with true-positive results. This finding suggests that patients with false-positive results on stress echocardiography should still receive intensive risk factor management and careful clinical follow-up.