PROGNOSTIC VALUE OF MYOCARDIAL VIABILITY AND ISCHEMIA DETECTED BY DOBUTAMINE STRESS ECHOCARDIOGRAPHY EARLY AFTER ACUTE MYOCARDIAL-INFARCTION TREATED WITH THROMBOLYSIS

Objectives. The aim of the study was to assess the prognostic value of myocardial viability and ischemia detected by dobutamine stress echoc ardiography (DSE) in patients with acute myocardial infarction (AMI) t reated with thrombolysis. Background. DSE can detect myocardial viabil ity and ischemia early after AMI, but the prognostic importance of via bility and ischemia in these patients has yet to be assessed. Methods. DSE was performed in 152 patients at a mean of 9 +/- 5 days after a f irst AMI treated with thrombolysis to evaluate myocardial viability an d ischemia. The patients were followed up for 15 +/- 19 months. Result s. On the basis of DSE results three groups of patients were identifie d: group 1 (95 patients, 62.5%) with myocardial viability and ischemia , group 2 with myocardial viability without ischemia (32 patients, 21% ) and group 3 (25 patients, 16.5%) with no myocardial viability. Durin g follow-np 10 patients (6.5%) had hard events, 53 (35%) developed uns table angina and 67 (44%) underwent myocardial revascularization. The rate of hard events was 10% in group 1 and 0% in group 2 and 3 patient s (p < 0.05 group 1 versus group 2); group 1 patients with viability a nd ischemia showed a significantly higher rate of recurrence of unstab le angina and myocardial revascularization procedures (40% and 60%) co mpared to group 2 (22% and 16%) and group 3 patients (20% and 20%). Us ing the Cox multivariate stepwise model, only the extent of ischemic m yocardium (hazard ratio (HR) = 21.7, p = 0.02) and angina during DSE ( HR = 4.45, p = 0.03) were significant predictors of hard events; an is chemic response to DSE (HR = 2.92, p = 0.001) was the most important p redictor of spontaneous events, followed by ST-segment depression duri ng DSE (HR = 1.71, p = 0.04), angina during DSE (HR = 1.53, p = 0.19) and age (HR = 0.96, p = 0.05), Conclusions. In patients with a first A MI treated with thrombolysis the presence and extent of myocardial isc hemia during DSE is the most important predictor of both hard and spon taneous cardiac events, whereas myocardial viability does not have an independent prognostic value. (C) 1998 by the American College of Card iology.