Long Term Favorable Prognostic Value of Negative Treadmill Echocardiogram in the Setting of Abnormal Treadmill Electrocardiogram: A 95 Month Median Duration Follow-Up Study

Background: The aim of this retrospective study was to assess if negative treadmill echocardiographic (NTME) results retained their favorable prognosis over a long period of follow-up (median, 95 months) in the setting of ischemic stress electrocardiographic (ISECG) results. Methods: Consecutive patients with NTME results were analyzed as 2 groups (those with ISECG results and those with normal stress electrocardiographic results). Patients were followed up for a median duration of 95 months to identify major adverse cardiac events (MACEs), including all-cause death, myocardial infarction, and coronary revascularization. Results: Six hundred seventy-seven patients fulfilled the inclusion criteria. Fifty-eight patients had MACEs (8.6%). The annual event rate was 1%. There was an increased unadjusted rate of MACEs among patients with ISECG results (15% vs 8%; P = .025). After adjusting for clinical and stress variables, ISECG results were not independently predictive of MACEs (P = .2). Female gender, prior coronary artery disease, metabolic equivalents achieved, and chest pain at stress were the independent predictors of MACEs. Conclusions: Patients with NTME results had excellent long-term outcomes, regardless of ISECG results, over a median 95-month follow-up period. The findings of this study reaffirm the importance of benign long-term outcomes in the setting of good exercise capacity.