STRESS ECHOCARDIOGRAPHIC RESULTS PREDICT RISK OF REINFARCTION EARLY AFTER UNCOMPLICATED ACUTE MYOCARDIAL-INFARCTION - LARGE-SCALE MULTICENTER STUDY

Objectives. This study sought to assess the value of dipyridamole echo cardiography in predicting reinfarction in patients evaluated early af ter uncomplicated acute myocardial infarction. Background. The identif ication of future nonfatal reinfarction seems an elusive target for ph ysiologic testing. However, a large sample population is needed to det ect minor differences in phenomena with a low event rate. Methods. We assessed the value of dipyridamole echocardiography in predicting rein farction in 1,080 patients (mean [+/-SD] age 56 +/- 9 years; 926 men, 154 women) evaluated early (10 +/- 5 days) after uncomplicated acute m yocardial infarction and followed up for 14 +/- 10 months. Results. Su bmaximal studies due to limiting side effects occurred in 14 patients (1.3%); these test results were included in the analysis. Results of d ipyridamole echocardiography were positive in 475 patients (44%). Duri ng follow-up, there were 50 reinfarctions: 45 nonfatal, 5 fatal (follo wed by cardiac death less than or equal to 4 days after reinfarction). Reinfarction (either nonfatal or fatal) occurred in 30 patients with positive and 20 with negative results (6.3% vs. 3.3%, p < 0.01). Nonfa tal reinfarction occurred in 25 patients with positive and 20 with neg ative results (5% vs. 3.3%, p < 0.05). Reinfarction was fatal in 5 of 30 patients with positive and in none of 20 with negative results (16. 6% vs. 0%, p = 0.07). The relative risk of reinfarction was 1.9. Concl usions. Dipyridamole echocardiographic positivity identifies patients evaluated early after uncomplicated acute myocardial infarction at hig her risk of reinfarction, especially fatal reinfarction.