Prospective Randomized Comparison of Conventional Stress Echocardiography With Real Time Perfusion Stress Echocardiography in Predicting Clinical Outcome - POISE

Nov 04, 2012
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Author/Summarized by Author:
Anthony A. Bavry, MD, MPH, FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Date Presented:
01/01/2012
Date Updated:
11/04/2012
Original Posted Date:
11/04/2012
References

Description:

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.

Hypothesis:

Real-time myocardial contrast echocardiography will improve outcomes.

Study Design

  • Randomized
  • Parallel

Patient Populations:

  • 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%

Exclusions:

  • Hypersensitivity to ultrasound contrast agent
  • Pregnant or breast-feeding
  • Low probability of coronary artery disease
  • Paced rhythm

Primary Endpoints:

  • Death or nonfatal myocardial infarction

Secondary Endpoints:

  • Death, nonfatal myocardial infarction, or revascularization

Drug/Procedures Used:

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.

Principal Findings:

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.

Interpretation:

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.

References:

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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