MULTICENTER TRIAL ON PROGNOSTIC VALUE OF INDUCIBLE ISCHEMIA, ASSESSEDBY DOBUTAMINE STRESS ECHOCARDIOGRAPHY AND EXERCISE ELECTROCARDIOGRAPHY TEST, IN PATIENTS WITH UNCOMPLICATED MYOCARDIAL-INFARCTION, TREATED WITH THROMBOLYTIC THERAPY

Background Thrombolysis has reduced early and longterm mortality by ab out 20%; sometimes, however, there is a re-occlusion of the infarct re lated artery or an unsuccessful thrombolysis. In these situations, the re is a possible increase in detrimental events in the follow-up. Obje ctives. The aim of the study was to compare the prognostic value of do butamine echocardiography (DET) and ECG exercise test (EET)in pts subm itted to thrombolysis. Methods. One hundred and fifty-one pts, with ac ute uncomplicated myocardial infarction, were enrolled. The pts were a ble to perform EET and had a sufficient echocardiographic window; 58 h ad anterior myocardial infarction (38%), 79 had inferior (52%), 2 had lateral (1%), 12 had non-Q (8%). EET was performed with an initial loa d of 25 Watt, and thereafter, 25 W every two minutes. DET was performe d with step-wise infusion every three minutes (5, 10, 20, 30 and 40 mc g/kg/min.). If the target heart rate was not reached, a further dose o f 40 mcg/kg/min. together with atropine 0.25-1 mg was administered, in the absence of signs and symptoms of ischemia. Results. During a mean (+/- SD) follow-up period of 8 +/- 4.5 months (range 1-23), 16 sponta neous events happened (4 deaths, 5 non-fatal re-infarctions, 7 unstabl e angina). One-hundred and three EET (68%) were negative for ongoing i schaemia, while 48 were positive, 79 DET (52%) were negative for ongoi ng ischaemia and 72 were positive (48%). Statistical results: DET and EET had a sensitivity of 41% and 54%, a specificity of 57% and 74%, a positive predictive value of 7% and 14%, a negative predictive value o f 91% and 95%, an accuracy of 56% and 73%. Kaplan-Maier survival curve s demonstrated that patients with Peak Wall motion > 1.8 and EET score > 3, had the higher risk of spontaneous events. Conclusion. A few spo ntaneous events happened in the follow-up. These data demonstrate that patients treated with thrombolysis are not at high risk of spontaneou s events. DET and EET, therefore, have had a high negative predictive value. For this reason, we can conclude that pts with negative tests c an be considered at low risk and do not need any further investigation s.