PROGNOSTIC VALUE OF DIPYRIDAMOLE-ECHOCARDIOGRAPHY EARLY AFTER MYOCARDIAL-INFARCTION IN ELDERLY PATIENTS

Objectives. This study was conducted to assess the feasibility, safety and prognostic value of dipyridamole echocardiography in elderly pati ents recovering from an uncomplicated acute myocardial infarction in a subset analysis performed on the patients entered in the subproject ' 'residual ischemia'' of the Echo Persantine Italian Cooperative Study (EPIC). Background. Coronary heart disease accounts for two thirds of all deaths in the age group >65 gears, and >50% of ah patients admitte d to the hospital with acute myocardial infarction are >65 years old. The prognostic value of dipyridamole-induced left ventricular dysfunct ion was clearly established in patients evaluated early after acute in farction. Methods. In a subgroup analysis of the Echo Persantine Itali an Cooperative Study (EPIC), we assessed the value of dipyridamole ech ocardiography in predicting cardiac events in 190 elderly (greater tha n or equal to 65 years) patients (age 68.4 +/- 3.3 years, range 65 to 78; 147 men and 43 women) evaluated early (mean 10 days) after uncompl icated acute myocardial infarction and followed up for 14 +/- 9.8 mont hs. Results. There was no major side effect during dipyridamole echoca rdiography. A positive test result occurred in 85 patients (44.7%). Du ring follow-up, there were 62 events (14 cardiac deaths, 7 nonfatal re infarctions, 21 cases of class III of IV angina and 20 revascularizati on procedures). Of these 62 events, 44 occurred among 85 patients with positive dipyridamole echocardiography and 18 among 105 patients with negative dipyridamole echocardiography (52% vs. 17%, p<0.001). Sponta neous events (death, reinfarction, angina) occurred in 31 patients wit h positive and in 11 with negative dipyridamole echocardiography (36% vs. 10%, p<0.001). Hard events (myocardial infarction or death) occurr ed in 14 patients with positive and 7 with negative dipyrid amole echo cardiography (16% vs. 6%, p<0.05). Death occurred in 11 patients with positive and in 3 with negative dipyridamole echocardiography (13% ys. 3%, p<0.01). The positive Predictive value of positive dipyridamole e chocardiography and negative predictive value of negative dipyridamole echocardiography as related to the occurrence of ah events in the fol low-up period (death, reinfarction, angina, revascularization procedur es) were 52% and 83%, respectively. The relative risk (that is, the re lative risk of occurrence of future cardiac events in the group with p ositive dipyridamole echocardiography compared with that in those with negative dipyridamole echocardiography) was 3 for all events and 4.4 for death. Conclusions. Dipyridamole echocardiography was well tolerat ed by elderly patients and proved to be very effective in prognostic s tratification early after uncomplicated acute myocardial infarction, e ven when only survival was considered.