Prognostic value of dobutamine-atropine stress echocardiography early after acute myocardial infarction

Rosa Sicari, Eugenio Picano, Patrizia Landi, Alessandro Pingitore, Riccardo Bigi, Claudio Coletta, Joanna Heyman, Franco Casazza, Mario Previtali, Wilson Mathias, Claudio Dodi, Giovanni Minardi, Jorge Lowenstein, Xenya Garyfallidis, Lauro Cortigiani, Maria Aurora Morales, Mauro Raciti

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives. The aim of this multicenter, multinational, prospective, observational study was to assess the relative value of myocardial viability and induced ischemia early after uncomplicated myocardial infarction. Background. Dobutamine-atropine stress echocardiography allows evaluation of rest function (at baseline), myocardial viability (at low dose) and residual ischemia (peak dose, up to 40 μg with atropine up to 1 mg) in one test. Methods. Dobutamine-atropine stress echocardiography was performed 12 ± 5 days (mean ± SD) after a first uncomplicated acute myocardial infarction in 778 patients (677 men; mean age 58 ± 10 years) with technically satisfactory rest echocardiographic study results. Patients were followed-up for 9 ± 7 months. Results. Dobutamine-atropine stress echocardiographic findings were positive for myocardial ischemia in 436 of patients (56%) and negative in 342 (44%). During follow-up, there were 14 cardiac-related deaths (1.8% of the total cohort), 24 (2.9%) nonfatal myocardial infarctions and 63 (8%) hospital readmissions for unstable angina. One hundred seventy-four patients (22%) underwent coronary revascularization (bypass surgery or coronary angioplasty). Spontaneous events occurred in 61 of 436 patients with positive and 40 of 342 patients with negative findings on dobutamine-atropine stress echocardiography (14% vs. 12%, p = 0.3). When only spontaneously occurring events were considered, the most important predictor was myocardial viability (chi-square 9.7). Using the Cox proportional hazards model, only the presence of myocardial viability (hazard ratio [HR] 2.0, p <0.002) and age (HR 1.03, p <0.001) were predictive of spontaneously occurring events. When only hard cardiac events were considered, age was the strongest predictor (chi-square 3.6, p = 0.056), followed by wall motion score index (WMSI) at peak dose (chi-square 3.3, p = 0.06) and remote ischemia (chi-square 2.25, p = 0.1). When cardiac death was considered, WMSI at peak dose was the best predictor (HR 9.2, p <0.0001). Conclusions. During dobutamine stress, echocardiographic recognition of myocardial viability is more prognostically important than echocardiographic recognition of myocardial ischemia for predicting unstable angina, whereas WMSI at peak stress was the best predictor of cardiac-related death. Different events can be recognized with different efficiency by various stress echocardiographic variables.

Original languageEnglish
Pages (from-to)254-260
Number of pages7
JournalJournal of the American College of Cardiology
Volume29
Issue number2
DOIs
Publication statusPublished - Feb 1997

ASJC Scopus subject areas

  • Nursing(all)

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