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Stress echocardiography with 2019 updated pre-test probabilities – love or hate?
Session:
Painel 6- Doença Coronária 4
Speaker:
Luís Puga
Congress:
CPC 2020
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
12. Coronary Artery Disease (Chronic)
Subtheme:
12.3 Coronary Artery Disease – Diagnostic Methods
Session Type:
Posters
FP Number:
---
Authors:
Luís Puga; Rogerio Teixeira; Ana Rita M. Gomes; Diana Decampos; João Gameiro; José Pedro Sousa; Carolina Saleiro; Ana Botelho; Lino Gonçalves
Abstract
<p><strong>Background</strong>: Recent 2019 guidelines on chronic coronary syndromes have significantly downgraded pre-test probability (PTP) for the diagnosis of coronary artery disease (CAD) based on contemporary data. PTP may not clearly reflect clinical practice and needs testing in different cardiovascular risk settings and to be put to the test with real-world data.</p> <p><strong>Aims</strong>: Assess the results and outcome of patients referred for dobutamine stress-echo (DSE) for diagnosis of CAD if new PTP would have been applied.</p> <p><strong>Methods</strong>: We studied a sample of patients submitted to DSE for diagnosis CAD from august 2017 to July 2019. We assessed the 2013 ESC guidelines PTP and the new 2019 ESC guidelines PTP according to characteristics of chest pain, age and gender. We further divided our sample into two groups A (patients not reclassified in low PTP) vs B (patients reclassified in new low PTP, considered <15%) for outcome and prognosis comparison.</p> <p><strong>Results</strong>: Our sample consisted of 115 consecutive patients, mean age of 68,6±10,3 years old, 57% males. 81,7%(94) of the patients were referred due to chest pain (12,2%(14) typical, 40%(46) atypical and 29,6%(34) non-anginal). 30,9%(29) patients of the 94 with chest pain were newly reclassified with low PTP according to the new guidelines. 48,3%(14) of the newly reclassified patients with a new low PTP had a negative DSE, 31% (9) had a positive DSE and 20,7% (6) had a non-diagnostic DSE. Subsequently, 24% (7) had an invasive coronary angiography which identified CAD in 2 patients and 1 patient had a coronary CT scan which ruled out CAD. None of the patients were revascularized (due to non-significant CAD). Mean follow-up was 12,6±6,9 months. None of the patients from group B died during follow-up (A 3%(2/62) vs B 0%(0/27)). None of the newly reclassified patients reached the endpoints of death, acute coronary syndrome, stroke or coronary artery bypass graft surgery during follow up. </p> <p><strong>Conclusions</strong>: In our sample, deferring diagnostic testing in patients with new low PTP as recommended by the new ESC guidelines would have resulted in 30,9%(29/94) less DSE, 17%(7/41) less invasive coronary angiography and 1 less CT scan. Our results are in agreement with the new downgraded PTP with the aim of decreasing false positive tests in the low risk population.</p>
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