Prognostic significance of ST-segment elevation during dobutamine stress echocardiography

Background: Limited data are available concerning the significance of ST-segment elevation during dobutamine stress echocardiography (DSE). The purpose of this study was to assess the prognostic significance of new ST-segment elevation during DSE and its relationship to angiographic severity of coronary artery disease (CAD). Methods: From 4240 consecutive patients who had DSE, we identified 134 (3%) patients with new stress-induced ST-segment elevation ≥1 mm in at least two contiguous electrocardiographic leads. Significant CAD was considered as ≥50% diameter obstruction by angiography. Follow-up was obtained for cardiac events. Results: Age was 69 ± 10 years; 84 (63%) were men. ST-segment elevation developed in the anterior leads in 55 (41%), inferior leads in 100 (75%), and lateral leads in 54 (40%); 56 (42%) had ST elevation in more than one region. Dobutamine stress echocardiography was abnormal in all patients; 115 (86%) had ischemia. Coronary angiography was obtained in 69 (51%) patients. Stenosis was ≥70% diameter in 68 (99%) patients and multivessel in 53 (77%). Follow-up (2.6 ± 2.8 years) was obtained in all 134 patients. Events occurred in 103 (77%) patients, including death in 53, coronary revascularization in 33, myocardial infarction in 12, and unstable angina in 5. Event-free survival was 55% at 2 years, 38% at 4 years, and 28% at 5 years. Conclusions: Patients with stress-induced ST-segment elevation during DSE commonly have severe CAD and are at high risk for events during follow-up. These patients should be considered for coronary angiography.