Prospective Randomized Comparison of Conventional Stress Echocardiography With Real Time Perfusion Stress Echocardiography in Predicting Clinical Outcome - POISE
The goal of the trial was to evaluate real-time myocardial contrast echocardiography compared with conventional stress echocardiography among intermediate-risk patients undergoing evaluation of angina symptoms.
Real-time myocardial contrast echocardiography will improve outcomes.
- Intermediate-risk patients undergoing evaluation of angina symptoms
Number of screened applicants: 9,328
Number of enrollees: 2,063
Duration of follow-up: 6 months
Mean patient age: 60 years
Percentage female: 52%
Ejection fraction: 59%
- Hypersensitivity to ultrasound contrast agent
- Pregnant or breast-feeding
- Low probability of coronary artery disease
- Paced rhythm
- Death or nonfatal myocardial infarction
- Death, nonfatal myocardial infarction, or revascularization
Intermediate-risk patients with angina symptoms were randomized to real-time myocardial contrast echocardiography (n = 1,028) versus conventional stress echocardiography (n = 1,035).
In each group, the decision to perform exercise-stress or dobutamine-stress echocardiography was left to the referring physician.
Overall 2,063 patients were randomized. The mean age was 60 years, 52% were women, 26% had diabetes, and mean ejection fraction was 59%. An abnormal test was obtained in 26%, and 12% had a resting wall motion abnormality.
Event-free survival was similar in patients with an abnormal real-time myocardial contrast echocardiography versus an abnormal conventional stress echocardiography (p = 0.88), and was similar in patients with a normal real-time myocardial contrast echocardiography versus a normal conventional stress echocardiography (p = 0.87).
Among patients undergoing real-time myocardial contrast echocardiography, absence of a wall motion abnormality predicted event-free survival (p < 0.001), although among patients undergoing conventional stress echocardiography, absence of a wall motion abnormality did not predict event-free survival (p = 0.71).
Interpretation of real-time myocardial contrast echocardiography was better for experienced readers (>1,000 studies) than less experienced readers.
Among patients undergoing evaluation for angina symptoms, real-time myocardial contrast echocardiography resulted in similar event-free survival as conventional stress echocardiography. Resting wall motion abnormality during real-time myocardial contrast echocardiography was the most powerful predictor of an adverse outcome. Interpretation of real-time myocardial contrast echocardiography is dependent on the experience of the reader.
Presented by Dr. Thomas Porter at the American Heart Association Scientific Sessions, Los Angeles, CA, November 4, 2012.
Keywords: Dobutamine, Follow-Up Studies, Echocardiography, Stress, Exercise, Disease-Free Survival, Diabetes Mellitus
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