Imaging in ischaemic heart disease 365 Conclusions: Only one third of patients with exercise induced ST segment ele- vation in lead aVR exhibited significant LM/ostial LAD stenosis. Both, lower Duke treadmill score (≤-5) and more pronounced wall motion abnormalities with exer- cise (delta WMSI ≥ 0.47) had high sensitivity and specificity in the detection of this subset of patients. P2064 | BEDSIDE Long-term prognostic value of an exercise echocardiogram in patients admitted for low-intermediate risk chest pain G. Merchan Ortega 1 , J.C. Bonaque Gonzalez 1 , F.M. Valencia Serrano 1 , I. Ikuta 2 , N. Bolivar Herrera 1 , M.J. Aguado Martin 1 , F. Navarro Garcia 1 , F. Ramos Perales 1 , F. Ruiz Lopez 1 , M. Gomez Recio 1 . 1 Torrecardenas Hospital, Almeria, Spain; 2 Brigham and Women’s Hospital, Boston, United States of America Purpose: The aim of this study was to evaluate cardiovascular events in patients discharged from the hospital after an episode of low-intermediate risk chest pain using an exercise echocardiogram (EE) for risk stratification. Methods: We studied 200 consecutively discharged patients from a cardiology department of a tertiary care hospital after an episode of low-intermediate risk chest pain and an initial strategy for detecting ischemia by EE. Major cardiovas- cular events (death, non-fatal myocardial infarction, and angina with percutaneous coronary intervention) during follow-up were recorded. Univariate and multivariate analyses were performed with Cox proportional hazards methods. Results: EE was negative in 85% (n=170) of patients, which were discharged and followed. In the rest of the population (15%), with positive EE, coronary arteriog- raphy was performed showing significant coronary artery disease in 8%. Patients with positive EE demonstrated significant association with higher TIMI risk score (p=0.005) and sex (men, p=0.028). The mean follow-up was 13±1 months and 4.5% of patients experienced major cardiovascular events. In univariate analysis, major cardiovascular events were significant associated with diabetes mellitus (HR=5.29, 95% confidence interval [CI]: 1.32-21.16, p=0.018), TIMI risk score (HR=2.09, 95% CI: 1.23-3-53, p=0.006) and positive EE (HR=22.66, 95% CI: 14.70-109.14, p<0.001). Additionally, patients with positive EE were associated with more major cardiovascular events, with independence of the existence of coronary revascularization during the hospitalization (p<0.001). In multivariate analysis, only a positive exercise echocardiogram was an independent predictor of major cardiovascular events during the follow-up period (HR=17.32, 95% CI 13.5-85.75, p<0.001). Conclusions: Positive exercise echocardiogram in patients discharged after low- intermediate risk chest pain appears to be an independent predictor of major cardiovascular events during a long-term follow-up, regardless of the therapeutic strategy used during the hospitalization. P2065 | BEDSIDE Follow-up of patients hospitalized for chest pain and negative exercise echocardiogram, can we be sure? G. Merchan Ortega, J.C. Bonaque Gonzalez, F.M. Valencia Serrano, N. Bolivar Herrera, R. Ferrer Lopez, M.J. Aguado Martin, F. Navarro Garcia, F. Ramos Perales, F. Ruiz Lopez, M. Gomez Recio. Torrecardenas Hospital, Almeria, Spain Purpose: The goal of this study was to evaluate cardiovascular outcomes in pa- tients discharged from the hospital after an episode of low-intermediate risk chest pain and a negative exercise echocardiogram. Methods: We studied 154 consecutively discharged patients from the cardiology service of a tertiary care hospital after an episode of low-intermediate risk chest pain and negative exercise echocardiogram. Major cardiovascular events (death, non-fatal myocardial infarction, and angina with percutaneous coronary interven- tion) during follow up were recorded. Results: The mean age of the studied population was 60±13 years, 58% men. 26% had diabetes mellitus and 32% had coronary artery disease (CAD). During a mean follow-up of 13±1 months, only 1% of the population experienced major cardiovascular event. For the cardiovascular risk factors studied [age (p=0.281), hypertension (p=0.630), smoking (p=0.655), diabetes mellitus (p=0.720), dyslipi- demia (p=0.595), men (p=0.588), CAD (p=0.689)], we didn’t find significant as- sociation in univariable Cox models with major cardiovascular events. However, the negative exercise echocardiogram showed a good discriminatory ability for prediction of major cardiovascular events during follow-up (ROC area under the curve: 0.84, 95% confidence interval: 0.720-0.969; p<0.001), with a sensitivity of 89%, and a negative predictive value of 99%. Conclusions: The value of a negative exercise echocardiogram in patient admit- ted for low-intermediate risk chest pain seems to provide prognostic information beyond the acute event, suggesting an excellent ability to predict major cardio- vascular events during a long-term follow-up. P2066 | BEDSIDE Stress echocardiography has superior accuracy and is more cost effective for predicting coronary artery disease in patients with suspected angina compared to exercise ECG K. Zacharias 1 , S. Ahmadvazir 1 , B.N. Shah 1 , J. Pabla 1 , R.S. Khattar 2 , R. Senior 3 . 1 Northwick Park Hospital, Harrow, United Kingdom; 2 Royal Brompton Hospital, London, United Kingdom; 3 Northwick Park Hospital* and Royal Brompton Hospital, Harrow*, London, United Kingdom Purpose: Exercise ECG (ExECG) is widely used to assess patients with sus- pected coronary artery disease (CAD). However stress echocardiography (SE) is a well-established alternative technique for the assessment of these patients. We hypothesised that SE, due to its greater accuracy and feasibility, may be superior to ExECG, in terms of positive predictive value and cost effectiveness, when used as the initial test for the assessment of patients with no previous history of CAD presenting with suspected stable angina. Methods: Patients referred with recent onset chest pain during 2011, with no known history of CAD and with a pre-test likelihood of CAD greater than 10%, who underwent first line ExECG or SE were identified. The tests were classified as positive, negative or inconclusive for ischaemia. Coronary angiography (CA) was performed, with the knowledge of the functional test results, as indicated clinically. CAD was defined as the presence of >50% stenosis in at least one major epicardial vessel on CA. Cost to diagnosis of CAD was determined for each functional test by adding the initial cost, of the test to the cost of subsequent tests leading to and including CA. Follow up data on hard events, cardiac death and acute myocardial infarction (AMI), were collected on all patients for a period up to one year after the presentation of the last study patient. Results: We identified 457 patients who underwent ExECG (225 (49%) nega- tive, 94 (21%) positive, 138 (30%) inconclusive) and 257 who underwent SE (213 (83%) negative, 38 (15%) positive, 6 (2%) inconclusive) as first line. The mean pre-test probability of CAD was 43±26% vs 51±28% respectively. Of 74 patients referred for CA on the basis of ExECG, CAD was present in 35 (47%) which was significantly (p=0.04) lower than in the SE group which predicted CAD in 28 out of 42 patients referred for CA (67%). The mean cost to diagnosis was £460 for the ExECG versus £385 for the SE group (p=0.02). No cardiac deaths were found in either group. There was no difference in event rate, (p=0.8 by log rank test) of AMI in patients who were discharged on the basis of a negative ExECG (4 (2%)) versus those with a negative SE (4 (2%)) over a period of 18±6 months. Conclusions: In a population with intermediate pre-test probability of CAD, SE was more accurate and more cost effective for predicting the presence of CAD compared to ExECG. This study suggests that SE rather than ExECG should be the initial test for the assessment of suspected stable angina in this population. P2067 | BEDSIDE Comparison of two strategies in a chest pain unit: stress-echocardiography and multidetector computed tomography M. Pineiro-Portela 1 , J. Peteiro-Vazquez 2 , F. Pombo 2 , D. Martinez 2 , J.C. Yanez 2 , A. Bouzas 2 , A. Castro-Beiras 2 . 1 Complejo Hospitalario Universitario Arquitecto Marcide, Ferrol (A CORUNA), Spain; 2 Complexo Hospitalario Universitario A Coruna, A Coruna, Spain Purpose: This study aimed to compare stress-echocardiography (SE) and multi- detector computed tomography (MCT) in patients admitted to a chest pain unit Methods: A total of 167 patients referred to our chest pain unit for acute chest pain with ≥2 cardiovascular risk factors, no ischemic ECG changes and negative biomarkers were randomized to SE (n=88) or MCT (n=77). Hard events (cardio- vascular death and non-fatal myocardial infarction), combined events (hard events and revascularizations), and combined events plus readmissions were studied during follow-up. Costs were assessed taken into account the cost of each tech- nique, angiographies, revascularizations and hospital stays. Results: Mean age was 63±11 years and 110 patients were male. Hypertension was seen in 73%, hypercholesterolemia in 78%, diabetes mellitus in 28%, and smoking in 23%. Most of the patients had a low TIMI risk score (72% TIMI I and 27% TIMI II). Mean follow-up was 10±4 months. Invasive angiography due to positive/nonconclusive results was performed in 29 of the 88 patients submitted to SE and in 18 of the 77 submitted to MCT (33% vs. 23%, p=0.15). A final diagnosis of acute coronary syndrome was achieved in 41 patients (26 in the SE group and 15 in the MCT group). There were no significant differences between groups (log rank test, p=NS) in hard events (1 patient in each group), combined events (24 patients [27%] in the SE group and 13 [17%] in the MCT group), and combined events plus readmissions (25 patients in the SE group [28%] and 15 in the MCT [19%]). The mean stay in hospital was 3.0±5.5 days in the SE group and 2.2±4.9 in the MCT group (p=NS). For patients with negative results by either technique the mean stay was less than 24 hours. Mean cost was 933±967 for patients with negative SE vs. 819±903 for patients with negative MCT (p=NS); and 9993±5520 for patients with positive SE vs. 9261±4182 for patients with positive MCT (p=NS) Conclusions: Both MCT and SE are equally effective for the stratification of pa- tients with low to moderate probability of coronary artery disease admitted to a chest pain unit. In this preliminary study, the cost of a MCT strategy was slightly lower than the cost of a SE strategy. Downloaded from https://academic.oup.com/eurheartj/article-abstract/34/suppl_1/P2065/2860816 by guest on 16 June 2020