PROGNOSTIC VALUE OF DIPYRIDAMOLE-ECHOCARDIOGRAPHY EARLY AFTER UNCOMPLICATED MYOCARDIAL-INFARCTION - A LARGE-SCALE, MULTICENTER TRIAL

PURPOSE: To determine the prognostic capability of the dipyridamole ec hocardiography test (DET) early after an acute myocardial infarction. PATIENTS AND METHODS: On the basis of 11 different echocardiographic l aboratories, all with established experience in stress echocardiograph y and fulfilling quality-control requirements for stress echocardiogra phic readings, 925 patients were evaluated after a mean of 10 days fro m an acute myocardial infarction and followed up for a mean of 14 mont hs. RESULTS: During the follow-up, there were 34 deaths and 37 nonfata l myocardial infarctions; 104 patients developed class III or IV angin a and 149 had coronary revascularization procedures (bypass or angiopl asty). Considering all spontaneous events (angina, reinfarction, and d eath), the most important univariate predictor was the presence of an inducible wall motion abnormality after dipyridamole administration (c hi2 = 45.8). With a Cox analysis, echocardiographic positivity, age, a nd male gender were found to have an independent and additive value. C onsidering survival (and, therefore, death as the only event), age was the most meaningful parameter, followed by the wall motion score inde x during dipyridamole administration (chi2 = 12.1). Among other parame ters, the resting wall motion score index was a significant predictor of death. In a multivariate analysis, the prognostic contributions of age (relative risk estimate = 1.08) and wall motion score index during dipyridamole administration (relative risk estimate = 4.1) were indep endent and additive. In particular, considering death only, the event rate was 2% in patients with negative DET results, 4% in patients with positive high-dose DET results, and 7% in patients with positive low- dose DET results. CONCLUSIONS: DET is feasible and safe early after un complicated myocardial infarction and allows effective risk stratifica tion on the basis of the presence, severity, extent, and timing of the induced dyssynergy.