Dobutamine stress echocardiography ischemia as a predictor of the placebo-controlled efficacy of percutaneous coronary intervention in stable coronary artery disease: the stress echo-stratified analysis of ORBITA
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background
Dobutamine stress echocardiography (DSE) is widely used to test for ischemia in patients with stable coronary artery disease (CAD). In this analysis we studied the ability of pre-randomization stress echo score to predict the placebo-controlled efficacy of percutaneous coronary intervention (PCI) within the ORBITA trial.
Methods
One hundred and eighty-three patients underwent DSE before randomization. The stress echo score is broadly the number of segments abnormal at peak stress, with akinetic segments counting double and dyskinetic segments counting triple. The ability of pre-randomization stress echo to predict the placebo-controlled effect of PCI on response variables was tested using regression modelling.
Results
At pre-randomization, the stress echo 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 pre-randomization stress echo score and the effect of PCI on angina frequency score with a larger placebo-controlled effect in patients with the highest stress echo score (pinteraction=0.031). With our sample size we were unable to detect an interaction between stress echo score and any other patient-reported response variables: freedom from angina (pinteraction=0.116), physical limitation (pinteraction=0.461), quality of life (pinteraction=0.689), EQ-5D-5L quality of life score (pinteraction=0.789) or between stress echo score and physician-assessed Canadian Cardiovascular Society angina class (pinteraction=0.693), and treadmill exercise time (pinteraction=0.426).
Conclusions
The degree of ischemia assessed by DSE predicts the placebo-controlled efficacy of PCI on patient-reported angina frequency. The greater the downstream stress echo abnormality caused by a stenosis, the greater the reduction in symptoms from PCI.
Dobutamine stress echocardiography (DSE) is widely used to test for ischemia in patients with stable coronary artery disease (CAD). In this analysis we studied the ability of pre-randomization stress echo score to predict the placebo-controlled efficacy of percutaneous coronary intervention (PCI) within the ORBITA trial.
Methods
One hundred and eighty-three patients underwent DSE before randomization. The stress echo score is broadly the number of segments abnormal at peak stress, with akinetic segments counting double and dyskinetic segments counting triple. The ability of pre-randomization stress echo to predict the placebo-controlled effect of PCI on response variables was tested using regression modelling.
Results
At pre-randomization, the stress echo 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 pre-randomization stress echo score and the effect of PCI on angina frequency score with a larger placebo-controlled effect in patients with the highest stress echo score (pinteraction=0.031). With our sample size we were unable to detect an interaction between stress echo score and any other patient-reported response variables: freedom from angina (pinteraction=0.116), physical limitation (pinteraction=0.461), quality of life (pinteraction=0.689), EQ-5D-5L quality of life score (pinteraction=0.789) or between stress echo score and physician-assessed Canadian Cardiovascular Society angina class (pinteraction=0.693), and treadmill exercise time (pinteraction=0.426).
Conclusions
The degree of ischemia assessed by DSE predicts the placebo-controlled efficacy of PCI on patient-reported angina frequency. The greater the downstream stress echo abnormality caused by a stenosis, the greater the reduction in symptoms from PCI.
Date Issued
2019-11-11
Date Acceptance
2019-09-24
Citation
Circulation, 2019, 140 (24), pp.1971-1980
ISSN
0009-7322
Publisher
American Heart Association
Start Page
1971
End Page
1980
Journal / Book Title
Circulation
Volume
140
Issue
24
Copyright Statement
© 2019 The Authors. Circulation is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited.
Sponsor
Wellcome Trust
Wellcome Trust
British Heart Foundation
Imperial College Healthcare NHS Trust- BRC Funding
British Heart Foundation
Imperial College Healthcare NHS Trust- BRC Funding
Medical Research Council (MRC)
British Heart Foundation
British Heart Foundation
Identifier
http://ahajournals.org/doi/10.1161/CIRCULATIONAHA.119.042918
Grant Number
PS3162_WHCP
203928/Z/16/Z
FS/10/38/28268
RDB02
FS/14/13/30619
RDB02
G1100443
FS/12/12/29294
FS/14/27/30752
Subjects
Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Peripheral Vascular Disease
Cardiovascular System & Cardiology
angina
stable
coronary artery disease
echocardiography
stress
percutaneous coronary intervention
FRACTIONAL FLOW RESERVE
OPTIMAL MEDICAL THERAPY
GUIDED PCI
ANGIOPLASTY
REVASCULARIZATION
OUTCOMES
angina, stable
coronary artery disease
echocardiography, stress
percutaneous coronary intervention
Aged
Angina, Stable
Coronary Artery Disease
Dobutamine
Echocardiography, Stress
Exercise Tolerance
Female
Humans
Ischemia
Male
Middle Aged
Percutaneous Coronary Intervention
Quality of Life
Humans
Ischemia
Dobutamine
Echocardiography, Stress
Exercise Tolerance
Quality of Life
Aged
Middle Aged
Female
Male
Coronary Artery Disease
Angina, Stable
Percutaneous Coronary Intervention
Cardiovascular System & Hematology
1102 Cardiorespiratory Medicine and Haematology
1103 Clinical Sciences
1117 Public Health and Health Services
Publication Status
Published
Date Publish Online
2019-11-11