POSITIVE HIGH-DOSE DIPYRIDAMOLE-ECHOCARDIOGRAPHY TEST AFTER ACUTE MYOCARDIAL-INFARCTION IS AN EXCELLENT PREDICTOR OF CARDIAC EVENTS

To determine the prognostic value of the high-dose (0.84 mg/kg over a 10-minute period) dipyridamole echocardiography test (DET) after a fir st acute myocardial infarction (AMI) in comparison with clinical, elec trocardiographic, echocardiographic, and angiographic variables, follo w-up data over an average period of 16 months were obtained in 93 cons ecutive patients. There were 41 total cardiac events (TCE): one death, two reinfarctions, 13 postinfarction anginas, five percutaneous trans luminal coronary angioplasty procedures, and 20 coronary artery bypass graft procedures. TCE without revascularization procedures were consi dered adverse cardiac events (ACE). The DET result was positive in 28 of 41 patients with TCE and in only 4 of 52 patients without TCE (p < 0.001), The sensitivity, specificity, and accuracy of positive DET in predicting TCE were 68%, 92%, and 82%, respectively. According to Cox' s proportional regression model the best predictor of TCE was positivi ty of DET (p = 0.002, relative risk ratio 4.3), followed by multivesse l coronary artery disease (p = 0.018, relative risk ratio 2.9) and pat ent infarct-related artery (p = 0.042, relative risk ratio 2.9). DET w as positive in 12 of 16 patients with ACE and 20 of 77 patients withou t ACE (p = 0.001). The sensitivity, specificity, and accuracy of DET i n predicting ACE were 75%, 74%, and 74%, respectively. According to Co x's proportional regression model significant predictors of ACE were p ositivity of DET (p = 0.002, relative risk ratio 29.4) and ejection fr action less than or equal to 40% at the time of DET (p = 0.017, relati ve risk ratio 22.2). These data indicate that the positivity of DET is an excellent predictor of cardiac events after AMI and is more powerf ul as a predictor than the extent of coronary artery disease, suggesti ng its ability to identify ''functionally'' critical stenosis. A posit ive DET result can identify high-risk patients after AMI who should un dergo coronary angiography and may benefit from revascularization proc edures.