Prognostic interaction between viability and residual myocardial ischemia by dobutamine stress echocardiography in patients with acute myocardial infarction and mildly impaired left ventricular function

Dobutamine stress echocardiography (DSE) accurately detects viable myocardi um and residual ischemia in patients with acute myocardial infarction (AMI) , The prognostic interaction of viability and ischemia has not been complet ely clarified in these patients, This study assesses the long-term effect o f viability, ischemia, or their combination on survival in patients with AM I and mildly impaired left ventricular (LV) function. Four hundred eleven p atients (age 57 +/- 9 years) underwent predischarge DSE (vp to 40 mug/kg/mi n plus atropine if needed) after uncomplicated AMI and were prospectively f ollowed for 23 months (range 1 to 78), According ta DSE findings, patients were divided into 4 groups: viability only, ischemia only, combination of v iability and ischemia, and scar. Adverse outcome occurred in 64 patients: 3 4 patients had hard events (9 cardiac deaths, 25 nonfatal AMI) and 30 patie nts had unstable angina requiring hospitalization. The combination of viabi lity and ischemia, diabetes mellitus, and non-Q-wave AMI were significant p redictors of all events at univariate and multivariate analysis. The same v ariables were also univariate predictors of hard events, but multivariate a nalysis indicated only the combination of viability and ischemia and diabet es as independent predictors. The event-free survival of patients with comb ined viability and ischemia was significantly lower (hazard ratio 3 [95% co nfidence interval 1.8 to 11]) compared with patients with ischemia only. Th us, viability and ischemia show a significant adverse prognostic interactio n in patients with AMI and preserved LV function, (C) 2001 by Excerpta Medi co, Inc.