DOBUTAMINE STRESS ECHOCARDIOGRAPHY FOR RISK STRATIFICATION AFTER MYOCARDIAL-INFARCTION

Background Because dobutamine stress echocardiography (DSE) provides a ssessment of left ventricular function and ischemia at a distance, the major determinants of adverse outcome after acute myocardial infarcti on (AMI), we undertook this study to determine the role of DSE in risk stratification after AMI. Methods and Results A graded DSE in 5-minut e stages was performed in 214 patients (age. 57+/-13 years [mean+/-SD] ) at 2 to 7 days after AMI. Coronary angiography was performed in 193 patients. Follow-up data regarding major cardiac events were obtained through telephone interviews and chart reviews. All patients were foll owed for greater than or equal to 500 days or until a hard cardiac eve nt occurred. The mean follow-up interval was 494+/-182 days after AMI. Peak heart rate and systolic blood pressure were 115+/-21 bpm and 135 +/-29 mm Hg, respectively. An adverse outcome occurred in 80 of 214 pa tients; cardiac death occurred in 15 nonfatal AMI occurred in 15, sust ained or symptomatic ventricular arrhythmia occurred in 5, congestive heart failure occurred in 14, and unstable angina occurred in 31. Sign ificant predictors of adverse outcome by univariate analysis were prio r myocardial infarction (P=.005), anterior infarction (P=.006), multiv essel coronary artery disease (P<.0001), global resting left ventricul ar wall motion score index (P<.0001), infarction zone nonviability bas ed on akinesis unresponsive to low-dose dobutamine (P<.0001), and isch emia/infarction at a distance (P<.0001). Furthermore, the extent of in farct zone and nonviability correlated with the severity of the cardia c event. Multivariate analysis of clinical, angiographic, and DSE vari ables revealed that the only independent predictors of adverse outcome were ischemia/infarction at a distance (P<.0001) and infarction zone nonviability (P<.0001). Multivessel disease identified through DSE was more predictive of adverse outcome than was angiographically determin ed multivessel disease. Conclusions DSE can be used to predict adverse outcomes after AMI.