Prognostic value of residual ischaemia assessed by exercise electrocardiography and dobutamine stress echocardiography in low-risk patients following acute myocardial infarction

R. Bigi, A. Galati, G. Curti, C. Coletta, S. Barlera, N. Partesana, L. Bordi, V. Ceci, G. Occhi, C. Fiorentini

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Background. Risk stratification after uncomplicated myocardial infarction is a major clinical problem. In particular, the prognostic value of residual inducible ischaemia is still controversial. We compared the relative prognostic value of exercise ECG and dobutamine stress echocardiography performed in the early post-infarction period. Methods. Four hundred and six patients (53 female) aged 57 ± 9 years, undergoing maximal exercise ECG and dobutamine stress echocardiography within 10 days of an uncomplicated myocardial infarction off therapy, were prospectively followed-up for 8.8 months. Age, sex, diabetes, smoking habit, hypertension, dyslipidaemia, infarct location, thrombolysis and resting wall motion score index were taken into account among clinical variables. Prognostic correlations were made vs spontaneous events (cardiac death, non-fatal reinfarction and unstable angina requiring hospitalization) whilst patients undergoing revascularization (by means of percutaneous transluminal coronary angioplasty or coronary artery bypass surgery) at the time of the procedure were censored. Results. One hundred and twenty-seven events occurred during the follow-up: 41 (10%) were spontaneous (five deaths, 12 reinfarctions and 24 unstable angina) and 86 procedural (27 angioplasty and 59 bypass surgery). Spontaneous events were not predicted by any clinical, exercise ECG or dobutamine stress echocardiography variable, but the negative predictive value of both tests was excellent (91% and 90%, respectively). With a multivariate Cox analysis, male gender, positive low-workload (<100 W) exercise ECG (P <0.0001), positive low-dose dobutamine stress echocardiography (P <0.0001) and rest-stress wall motion score index variation (P <0.001) were found to predict cumulative cardiac events with an independent and additive value. Dobutamine stress echocardiography was significantly more sensitive (P <0.05) and less specific (P <0.01) in predicting the outcome of patients with anterior infarction, whilst exercise ECG was significantly more sensitive (P <0.05) in patients with non-Q wave infarction. Conclusions. (1) Spontaneous events are poorly predicted by provocative tests in low-risk patients after uncomplicated myocardial infarction. (2) However, both exercise ECG and dobutamine stress echocardiography can predict a favourable outcome with a very high negative predictive value. (3) Dobutamine stress echocardiography should be considered a secondary option in cases where the exercise ECG is equivocal or when the location of ischaemia is a relevant issue. (4) The possibility that the two tests have a differential utility depending on the infarct location and type (Q wave vs non-Q wave) may be clinically relevant and deserves further evaluation.

Original languageEnglish
Pages (from-to)1873-1881
Number of pages9
JournalEuropean Heart Journal
Volume18
Issue number12
Publication statusPublished - 1997

Fingerprint

Stress Echocardiography
Electrocardiography
Ischemia
Myocardial Infarction
Exercise
Infarction
Unstable Angina
Predictive Value of Tests
Coronary Balloon Angioplasty
Dyslipidemias
Workload
Angioplasty
Coronary Artery Bypass
Habits
Hospitalization
Multivariate Analysis
Smoking
Hypertension

Keywords

  • Dobutamine
  • Exercise ECG
  • Prognosis after myocardial infarction
  • Risk stratification
  • Stress echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Prognostic value of residual ischaemia assessed by exercise electrocardiography and dobutamine stress echocardiography in low-risk patients following acute myocardial infarction. / Bigi, R.; Galati, A.; Curti, G.; Coletta, C.; Barlera, S.; Partesana, N.; Bordi, L.; Ceci, V.; Occhi, G.; Fiorentini, C.

In: European Heart Journal, Vol. 18, No. 12, 1997, p. 1873-1881.

Research output: Contribution to journalArticle

Bigi, R. ; Galati, A. ; Curti, G. ; Coletta, C. ; Barlera, S. ; Partesana, N. ; Bordi, L. ; Ceci, V. ; Occhi, G. ; Fiorentini, C. / Prognostic value of residual ischaemia assessed by exercise electrocardiography and dobutamine stress echocardiography in low-risk patients following acute myocardial infarction. In: European Heart Journal. 1997 ; Vol. 18, No. 12. pp. 1873-1881.
@article{b6faf736348a4117af8c2a45050afc43,
title = "Prognostic value of residual ischaemia assessed by exercise electrocardiography and dobutamine stress echocardiography in low-risk patients following acute myocardial infarction",
abstract = "Background. Risk stratification after uncomplicated myocardial infarction is a major clinical problem. In particular, the prognostic value of residual inducible ischaemia is still controversial. We compared the relative prognostic value of exercise ECG and dobutamine stress echocardiography performed in the early post-infarction period. Methods. Four hundred and six patients (53 female) aged 57 ± 9 years, undergoing maximal exercise ECG and dobutamine stress echocardiography within 10 days of an uncomplicated myocardial infarction off therapy, were prospectively followed-up for 8.8 months. Age, sex, diabetes, smoking habit, hypertension, dyslipidaemia, infarct location, thrombolysis and resting wall motion score index were taken into account among clinical variables. Prognostic correlations were made vs spontaneous events (cardiac death, non-fatal reinfarction and unstable angina requiring hospitalization) whilst patients undergoing revascularization (by means of percutaneous transluminal coronary angioplasty or coronary artery bypass surgery) at the time of the procedure were censored. Results. One hundred and twenty-seven events occurred during the follow-up: 41 (10{\%}) were spontaneous (five deaths, 12 reinfarctions and 24 unstable angina) and 86 procedural (27 angioplasty and 59 bypass surgery). Spontaneous events were not predicted by any clinical, exercise ECG or dobutamine stress echocardiography variable, but the negative predictive value of both tests was excellent (91{\%} and 90{\%}, respectively). With a multivariate Cox analysis, male gender, positive low-workload (<100 W) exercise ECG (P <0.0001), positive low-dose dobutamine stress echocardiography (P <0.0001) and rest-stress wall motion score index variation (P <0.001) were found to predict cumulative cardiac events with an independent and additive value. Dobutamine stress echocardiography was significantly more sensitive (P <0.05) and less specific (P <0.01) in predicting the outcome of patients with anterior infarction, whilst exercise ECG was significantly more sensitive (P <0.05) in patients with non-Q wave infarction. Conclusions. (1) Spontaneous events are poorly predicted by provocative tests in low-risk patients after uncomplicated myocardial infarction. (2) However, both exercise ECG and dobutamine stress echocardiography can predict a favourable outcome with a very high negative predictive value. (3) Dobutamine stress echocardiography should be considered a secondary option in cases where the exercise ECG is equivocal or when the location of ischaemia is a relevant issue. (4) The possibility that the two tests have a differential utility depending on the infarct location and type (Q wave vs non-Q wave) may be clinically relevant and deserves further evaluation.",
keywords = "Dobutamine, Exercise ECG, Prognosis after myocardial infarction, Risk stratification, Stress echocardiography",
author = "R. Bigi and A. Galati and G. Curti and C. Coletta and S. Barlera and N. Partesana and L. Bordi and V. Ceci and G. Occhi and C. Fiorentini",
year = "1997",
language = "English",
volume = "18",
pages = "1873--1881",
journal = "European Heart Journal",
issn = "0195-668X",
publisher = "Oxford University Press",
number = "12",

}

TY - JOUR

T1 - Prognostic value of residual ischaemia assessed by exercise electrocardiography and dobutamine stress echocardiography in low-risk patients following acute myocardial infarction

AU - Bigi, R.

AU - Galati, A.

AU - Curti, G.

AU - Coletta, C.

AU - Barlera, S.

AU - Partesana, N.

AU - Bordi, L.

AU - Ceci, V.

AU - Occhi, G.

AU - Fiorentini, C.

PY - 1997

Y1 - 1997

N2 - Background. Risk stratification after uncomplicated myocardial infarction is a major clinical problem. In particular, the prognostic value of residual inducible ischaemia is still controversial. We compared the relative prognostic value of exercise ECG and dobutamine stress echocardiography performed in the early post-infarction period. Methods. Four hundred and six patients (53 female) aged 57 ± 9 years, undergoing maximal exercise ECG and dobutamine stress echocardiography within 10 days of an uncomplicated myocardial infarction off therapy, were prospectively followed-up for 8.8 months. Age, sex, diabetes, smoking habit, hypertension, dyslipidaemia, infarct location, thrombolysis and resting wall motion score index were taken into account among clinical variables. Prognostic correlations were made vs spontaneous events (cardiac death, non-fatal reinfarction and unstable angina requiring hospitalization) whilst patients undergoing revascularization (by means of percutaneous transluminal coronary angioplasty or coronary artery bypass surgery) at the time of the procedure were censored. Results. One hundred and twenty-seven events occurred during the follow-up: 41 (10%) were spontaneous (five deaths, 12 reinfarctions and 24 unstable angina) and 86 procedural (27 angioplasty and 59 bypass surgery). Spontaneous events were not predicted by any clinical, exercise ECG or dobutamine stress echocardiography variable, but the negative predictive value of both tests was excellent (91% and 90%, respectively). With a multivariate Cox analysis, male gender, positive low-workload (<100 W) exercise ECG (P <0.0001), positive low-dose dobutamine stress echocardiography (P <0.0001) and rest-stress wall motion score index variation (P <0.001) were found to predict cumulative cardiac events with an independent and additive value. Dobutamine stress echocardiography was significantly more sensitive (P <0.05) and less specific (P <0.01) in predicting the outcome of patients with anterior infarction, whilst exercise ECG was significantly more sensitive (P <0.05) in patients with non-Q wave infarction. Conclusions. (1) Spontaneous events are poorly predicted by provocative tests in low-risk patients after uncomplicated myocardial infarction. (2) However, both exercise ECG and dobutamine stress echocardiography can predict a favourable outcome with a very high negative predictive value. (3) Dobutamine stress echocardiography should be considered a secondary option in cases where the exercise ECG is equivocal or when the location of ischaemia is a relevant issue. (4) The possibility that the two tests have a differential utility depending on the infarct location and type (Q wave vs non-Q wave) may be clinically relevant and deserves further evaluation.

AB - Background. Risk stratification after uncomplicated myocardial infarction is a major clinical problem. In particular, the prognostic value of residual inducible ischaemia is still controversial. We compared the relative prognostic value of exercise ECG and dobutamine stress echocardiography performed in the early post-infarction period. Methods. Four hundred and six patients (53 female) aged 57 ± 9 years, undergoing maximal exercise ECG and dobutamine stress echocardiography within 10 days of an uncomplicated myocardial infarction off therapy, were prospectively followed-up for 8.8 months. Age, sex, diabetes, smoking habit, hypertension, dyslipidaemia, infarct location, thrombolysis and resting wall motion score index were taken into account among clinical variables. Prognostic correlations were made vs spontaneous events (cardiac death, non-fatal reinfarction and unstable angina requiring hospitalization) whilst patients undergoing revascularization (by means of percutaneous transluminal coronary angioplasty or coronary artery bypass surgery) at the time of the procedure were censored. Results. One hundred and twenty-seven events occurred during the follow-up: 41 (10%) were spontaneous (five deaths, 12 reinfarctions and 24 unstable angina) and 86 procedural (27 angioplasty and 59 bypass surgery). Spontaneous events were not predicted by any clinical, exercise ECG or dobutamine stress echocardiography variable, but the negative predictive value of both tests was excellent (91% and 90%, respectively). With a multivariate Cox analysis, male gender, positive low-workload (<100 W) exercise ECG (P <0.0001), positive low-dose dobutamine stress echocardiography (P <0.0001) and rest-stress wall motion score index variation (P <0.001) were found to predict cumulative cardiac events with an independent and additive value. Dobutamine stress echocardiography was significantly more sensitive (P <0.05) and less specific (P <0.01) in predicting the outcome of patients with anterior infarction, whilst exercise ECG was significantly more sensitive (P <0.05) in patients with non-Q wave infarction. Conclusions. (1) Spontaneous events are poorly predicted by provocative tests in low-risk patients after uncomplicated myocardial infarction. (2) However, both exercise ECG and dobutamine stress echocardiography can predict a favourable outcome with a very high negative predictive value. (3) Dobutamine stress echocardiography should be considered a secondary option in cases where the exercise ECG is equivocal or when the location of ischaemia is a relevant issue. (4) The possibility that the two tests have a differential utility depending on the infarct location and type (Q wave vs non-Q wave) may be clinically relevant and deserves further evaluation.

KW - Dobutamine

KW - Exercise ECG

KW - Prognosis after myocardial infarction

KW - Risk stratification

KW - Stress echocardiography

UR - http://www.scopus.com/inward/record.url?scp=0030816974&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0030816974&partnerID=8YFLogxK

M3 - Article

C2 - 9447314

AN - SCOPUS:0030816974

VL - 18

SP - 1873

EP - 1881

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

IS - 12

ER -