Prognostic value of dipyridamole echocardiography early after uncomplicated myocardial infarction: A large-scale, multicenter trial

Eugenio Picano, Patrizia Landi, Leonardo Bolognese, Giacomo Chiarandà, Francesco Chiarella, Giovanni Seveso, Maria Grazia Sclavo, Nicola Gandolfo, Mario Previtali, Andrès Orlandini, Franca Margaria, Salvatore Pirelli, Ornella Magaja, Giovanni Minardi, Federico Bianchi, Cecilia Marini, Mauro Raciti, Claudio Michelassi, Silva Severi

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Abstract

purpose: To determine the prognostic capability of the dipyridamole echocardiography test (DET) early after an acute myocardial infarction. patients and methods: On the basis of 11 different echocardiographic laboratories, all with established experience in stress echocardiography and fulfilling quality-control requirements for stress echocardiographic readings, 925 patients were evaluated after a mean of 10 days from an acute myocardial infarction and followed up for a mean of 14 months. results: During the follow-up, there were 34 deaths and 37 nonfatal myocardial infarctions; 104 patients developed class III or IV angina and 149 had coronary revascularization procedures (bypass or angioplasty). Considering all spontaneous events (angina, reinfarction, and death), the most important univariate predictor was the presence of an inducible wall motion abnormality after dipyridamole administration (χ2 = 45.8). With a Cox analysis, echocardiographic positivity, age, and male gender were found to have an independent and additive value. Considering survival (and, therefore, death as the only event), age was the most meaningful parameter, followed by the wall motion score index during dipyridamole administration (χ2 = 12.1). Among other parameters, the resting wall motion score index was a significant predictor of death. In a multivariate analysis, the prognostic contributions of age (relative risk estimate = 1.08) and wall motion score index during dipyridamole administration (relative risk estimate = 4.1) were independent and additive. In particular, considering death only, the event rate was 2 % in patients with negative DET results, 4% in patients with positive high-dose DET results, and 7% in patients with positive low-dose DET results. conclusions: DET is feasible and safe early after uncomplicated myocardial infarction and allows effective risk stratification on the basis of the presence, severity, extent, and timing of the induced dyssynergy.

Original languageEnglish
Pages (from-to)608-618
Number of pages11
JournalAmerican Journal of Medicine
Volume95
Issue number6
DOIs
Publication statusPublished - 1993

ASJC Scopus subject areas

  • Nursing(all)

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    Picano, E., Landi, P., Bolognese, L., Chiarandà, G., Chiarella, F., Seveso, G., Sclavo, M. G., Gandolfo, N., Previtali, M., Orlandini, A., Margaria, F., Pirelli, S., Magaja, O., Minardi, G., Bianchi, F., Marini, C., Raciti, M., Michelassi, C., & Severi, S. (1993). Prognostic value of dipyridamole echocardiography early after uncomplicated myocardial infarction: A large-scale, multicenter trial. American Journal of Medicine, 95(6), 608-618. https://doi.org/10.1016/0002-9343(93)90357-U