PROGNOSTIC VALUE OF DOBUTAMINE ECHOCARDIOGRAPHY EARLY AFTER UNCOMPLICATED ACUTE MYOCARDIAL-INFARCTION - A COMPARISON WITH EXERCISE ELECTROCARDIOGRAPHY

Objectives. This study sought to assess the relative prognostic power of dobutamine echocardiography and exercise electrocar diography after acute myocardial infarction. Background. The prognostic value of dobu tamine echocardiography early after acute myocardial infarction has no t yet been reported. Methods. One hundred seventy-eight patients (mean age 58 +/- 9 years) with a first uncomplicated acute myocardial infar ction underwent predischarge dobutamine echocardiography (5 to 40 mu g /kg body weight per min, plus atropine if needed) and symptom-limited bicycle exercise electrocardiography and were followed up for 17 +/- 1 3 months. Stress induced dyssynergy and ST segment depression >1 mm we re considered criteria of positivity for dobutamine echocardiography a nd exercise electrocardiography, respectively. Results. Dobutamine ech ocardiography was positive in 83 patients and exercise electrocardiogr aphy in 60. At follow-up there were 5 deaths, 6 nonfatal myocardial in farctions (11 hard events) and 20 cases of unstable angina. Dobutamine echocardiography and exercise electrocardiography had similar negativ e predictive values both for all events (88% and 86%, respectively) an d for hard events (98% and 95%, respectively). The hard events rate wa s significantly higher in patients with positive rather than negative dobutamine echocardiography (relative risk [RR] 5.15, 95% confidence i nterval [CI] 1.14 to 23.16), although there was no difference between patients with positive and negative exercise electrocardiograms. When Cox analysis was performed, debutamine echocardiography had an indepen dent prognostic value both for all events (RR 2.88, 95% CI 1.37 to 6.0 8) and for hard events (RR 6.56, 95% CI 1.42 to 30.46). Conclusions. A fter uncomplicated acute myocardial infarction, dobutamine echocardiog raphy and exercise electrocardiography have a similar high negative pr edictive value for both all events and hard events only, Positive dobu tamine echocardiography, but not positive exercise electrocardiography , identifies a group of patients at higher risk of subsequent cardiac events. (C) 1997 by the American College of Cardiology.