SAFETY AND ACCURACY OF DOBUTAMINE-ATROPINE STRESS ECHOCARDIOGRAPHY FOR THE DETECTION OF RESIDUAL STENOSIS OF THE INFARCT-RELATED ARTERY ANDMULTIVESSEL DISEASE DURING THE FIRST WEEK AFTER ACUTE MYOCARDIAL-INFARCTION

Background The safety of dobutamine-atropine echocardiography early af ter acute myocardial infarction is unknown. Its accuracy for the early detection of infarct artery stenosis and multivessel coronary artery disease is also unclear. The objective of the present study was to doc ument its safety and accuracy during the first week after acute myocar dial infarction. Methods and Results Multistage dobutamine-atropine ec hocardiography was performed in 232 patients (age, 58+/-13 years; 58 w omen) at 5+/-2 days after acute myocardial infarction. The peak heart rate was 116+/-20 bpm. There were no episodes of sustained ventricular tachycardia, myocardial infarction, or death. Atropine with dobutamin e was tolerated well. Coronary angiography was performed in 206 patien ts (89%). There were 171 patients (83%) with infarct artery stenosis o f greater than or equal to 50% and 114 patients (55%) with multivessel disease. Ischemic or biphasic responses in the infarction zone were 8 2% (140 of 171) sensitive and 80% (28 of 35) specific for residual ste nosis. Sensitivity was similar for occluded arteries (77%, 36 of 47) a nd patent but stenotic arteries (84%, 104 of 124). Wall motion abnorma lities outside the infarction zone were specific (97%, 89 of 92) and m oderately sensitive (68%, 77 of 114) for multivessel disease. The only determinant of sensitivity for residual infarct artery stenosis was i mproved wall motion at low dose (P<.01). The determinants of sensitivi ty for multivessel disease were peak heart rate and infarct size (P<.0 1). Conclusions Dobutamine-atropine stress echocardiography was safely used to detect residual infarct artery stenosis and multivessel disea se during the first week after acute myocardial infarction. The test m ay be very effective for evaluating patients with acute myocardial inf arction because sensitivity for residual stenosis and multivessel dise ase was maximal in the high-risk subsets of patients with viable, jeop ardized myocardium and large infarct size.