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@article{Al-Lamee:2019:10.1161/CIRCULATIONAHA.119.042918,
author = {Al-Lamee, R and Shun-Shin, M and Howard, J and Nowbar, A and Rajkumar, C and Thompson, D and Sen, S and Nijjer, S and Petraco, R and Davies, J and Keeble, T and Tang, K and Malik, I and Bual, N and Cook, C and Ahmad, Y and Seligman, H and Sharp, A and Gerber, R and Talwar, S and Assomull, R and Cole, G and Keenan, N and Kanaganayagam, G and Sehmi, J and Wensel, R and Harrell, Jr F and Mayet, J and Thom, S and Davies, J and Francis, D},
doi = {10.1161/CIRCULATIONAHA.119.042918},
journal = {Circulation},
pages = {1971--1980},
title = {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},
url = {http://dx.doi.org/10.1161/CIRCULATIONAHA.119.042918},
volume = {140},
year = {2019}
}

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TY  - JOUR
AB  - BackgroundDobutamine 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. MethodsOne 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.ResultsAt 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). ConclusionsThe 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.
AU  - Al-Lamee,R
AU  - Shun-Shin,M
AU  - Howard,J
AU  - Nowbar,A
AU  - Rajkumar,C
AU  - Thompson,D
AU  - Sen,S
AU  - Nijjer,S
AU  - Petraco,R
AU  - Davies,J
AU  - Keeble,T
AU  - Tang,K
AU  - Malik,I
AU  - Bual,N
AU  - Cook,C
AU  - Ahmad,Y
AU  - Seligman,H
AU  - Sharp,A
AU  - Gerber,R
AU  - Talwar,S
AU  - Assomull,R
AU  - Cole,G
AU  - Keenan,N
AU  - Kanaganayagam,G
AU  - Sehmi,J
AU  - Wensel,R
AU  - Harrell,Jr F
AU  - Mayet,J
AU  - Thom,S
AU  - Davies,J
AU  - Francis,D
DO  - 10.1161/CIRCULATIONAHA.119.042918
EP  - 1980
PY  - 2019///
SN  - 0009-7322
SP  - 1971
TI  - 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
T2  - Circulation
UR  - http://dx.doi.org/10.1161/CIRCULATIONAHA.119.042918
UR  - http://ahajournals.org/doi/10.1161/CIRCULATIONAHA.119.042918
UR  - http://hdl.handle.net/10044/1/74587
VL  - 140
ER  -

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