Design and Setting
Observational study at a university hospital.

Patients
One hundred seventy-nine patients (mean age, 75 years; range, 70 to 90 years) referred for chest pain (n=73) or preoperative risk assessment for major vascular noncardiac surgery (n=106).

Measurements
All patients underwent clinical evaluation and dobutamine-atropine stress test.

Results
One hundred seventy-nine stress tests were performed. Test end points were the target heart rate (85% of theoretical maximum heart rate), reached in 165 tests (92%); inadequate echo images, two tests (1%); and side effects, 12 tests (7%). Side effects that caused a premature end of the test were severe chest pain (n=5 [2.8%]), electrocardiographic changes (n=1 [0.6%]), hypotension (n=2 [1.1%]), chills (n=2 [1.1%]), and cardiac arrhythmias (paroxysmal atrial fibrillation) (n=2 [1.1%]). New wall motion abnormalities as a marker of myocardial ischemia occurred in 50 tests (28%). No death or myocardial infarction occurred during the test. Perioperative events occurred in 12 patients (four cardiac deaths, three myocardial infarctions, and five episodes of unstable angina). During 16±6 months (mean±SD) of follow-up of 166 patients, 22 cardiac events occurred (eight cardiac deaths, four myocardial infarctions, and 10 episodes of unstable angina pectoris). By multivariate regression analysis, only perioperative cardiac events (odds ratio, 51; 95% confidence interval, 5.8 to 454) and late cardiac events (odds ratio, 5.2; 95% confidence interval, 2.0 to 14) were correlated with new wall motion abnormalities during stress.

Conclusion
Dobutamine-atropine stress echocardiography is a feasible and safe test for assessing elderly patients with suspected and/or proven coronary artery disease, providing useful prognostic information for perioperative and late cardiac risk with relatively few side effects.

(Arch Intern Med. 1994;154:2681-2686)