Dobutamine Stress Echocardiography Ischemia as a Predictor of the Placebo-Controlled Efficacy of Percutaneous Coronary Intervention in Stable Coronary Artery Disease The Stress Echocardiography-Stratified Analysis of ORBITA
Dobutamine Stress Echocardiography Ischemia as a Predictor of the Placebo-Controlled Efficacy of Percutaneous Coronary Intervention in Stable Coronary Artery Disease The Stress Echocardiography-Stratified Analysis of ORBITA
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DOI：
10.1161/circulationaha.119.042918
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发表时间：
2019-12-10
期刊：
影响因子：
37.8
通讯作者：
Francis, Darrel P.
中科院分区：
文献类型：
--
作者：
Al-Lamee, Rasha K.;Shun-Shin, Matthew J.;Francis, Darrel P.
背景：多巴酚丁胺应激超声心动图被广泛用于检测稳定型冠状动脉疾病患者的缺血。在本分析中，我们研究了在ORBITA试验（稳定型心绞痛血管成形术最佳药物治疗的随机盲法研究）中，随机化前应激超声心动图评分预测经皮冠状动脉介入治疗（PCI）安慰剂对照疗效的能力。方法：随机分组前，183例患者接受了多巴酚丁胺应激超声心动图检查。应激超声心动图评分大致是峰值应激时异常的节段数，其中运动节段数为两倍，非运动节段数为三倍。采用回归模型检验预随机化应激超声心动图预测PCI对反应变量的安慰剂控制效应的能力。结果：随机化前，PCI组（n=98）和安慰剂组（n=85）的应激超声心动图评分分别为1.561.77和1.611.73。随机化前应激超声心动图评分与PCI对心绞痛频率评分的影响之间存在可检测到的交互作用，且在应激超声心动图评分最高的患者中，安慰剂对照效应更大（p交互作用=0.031）。根据我们的样本量，我们无法发现应激超声心动图评分与任何其他患者报告的反应变量之间的相互作用：心绞痛自由度（P-interaction=0.116）、身体限制（P-interaction=0.461）、生活质量（P-interaction=0.689）、EuroQOL 5生活质量评分（P-interaction=0.789）、或应激超声心动图评分与医生评估的加拿大心血管学会心绞痛等级（P-interaction=0.693）和跑步机锻炼时间（P-interaction=0.426）之间的关系。结论：多巴酚丁胺应激超声心动图评估的缺血程度可预测PCI对患者报告的心绞痛频率的安慰剂对照疗效。狭窄引起的下游应激超声心动图异常越大，PCI后症状的减轻越大。
BACKGROUND: Dobutamine stress echocardiography is widely used to test for ischemia in patients with stable coronary artery disease. In this analysis, we studied the ability of the prerandomization stress echocardiography score to predict the placebo-controlled efficacy of percutaneous coronary intervention (PCI) within the ORBITA trial (Objective Randomised Blinded Investigation With Optimal Medical Therapy of Angioplasty in Stable Angina).METHODS: One hundred eighty-three patients underwent dobutamine stress echocardiography before randomization. The stress echocardiography score is broadly the number of segments abnormal at peak stress, with akinetic segments counting double and dyskinetic segments counting triple. The ability of prerandomization stress echocardiography to predict the placebo-controlled effect of PCI on response variables was tested by using regression modeling.RESULTS: At prerandomization, the stress echocardiography score was 1.561.77 in the PCI arm (n=98) and 1.611.73 in the placebo arm (n=85). There was a detectable interaction between prerandomization stress echocardiography score and the effect of PCI on angina frequency score with a larger placebo-controlled effect in patients with the highest stress echocardiography score (P-interaction=0.031). With our sample size, we were unable to detect an interaction between stress echocardiography score and any other patient-reported response variables: freedom from angina (P-interaction=0.116), physical limitation (P-interaction=0.461), quality of life (P-interaction=0.689), EuroQOL 5 quality-of-life score (P-interaction=0.789), or between stress echocardiography score and physician-assessed Canadian Cardiovascular Society angina class (P-interaction=0.693), and treadmill exercise time (P-interaction=0.426).CONCLUSIONS: The degree of ischemia assessed by dobutamine stress echocardiography predicts the placebo-controlled efficacy of PCI on patient-reported angina frequency. The greater the downstream stress echocardiography abnormality caused by a stenosis, the greater the reduction in symptoms from PCI.