Dipyridamole stress echocardiography and exercise testing for risk stratification after uncomplicated myocardial infarction.
BACKGROUND
Risk stratification for subsequent cardiac events after an acute infarction can be obtained by exercise testing or dipyridamole stress echocardiography. It remains to be determined whether these modalities are equivalent and provide incremental information on top of clinical evaluation. The aim of our study was to compare the prognostic information obtained early after an acute uncomplicated myocardial infarction of high dose dipyridamole coupled with echocardiography (stress echo) or maximal symptom-limited exercise testing.


RESULTS
Ninety patients underwent dipyridamole stress echo and exercise testing at a mean +/- SD of 9 +/- 4 days after admission for acute uncomplicated first myocardial infarction. All patients were prospectively followed for 22 +/- 16 months. There were 9 hard events (3 cardiac deaths and 6 acute myocardial infarctions) and 12 soft events due to post MI angina (6 angioplasty and 6 bypass surgery procedures). Univariate predictor of hard events was rest-stress wall motion score index variation (p = 0.009); univariate predictors of all events (hard + soft) were: positive exercise testing (p = 0.001), positive stress echo (p = 0.001), rest-stress wall motion score index variation (p = 0.002), extent of ischemia at echo (p = 0.008). Multivariate analysis by Cox selected a non-Q wave infarction and rest-stress wall motion score index variation as predictors of death or reinfarction (overall chi-square for the model 12.2, p = 0.0022).


CONCLUSIONS
Stress echo is superior to ergometric variables for predicting events after uncomplicated myocardial infarction.
Coronary Care Unit, S. Giacomo Hospital, Castelfranco Veneto, TV.
A
A
Desideri
G L
GL
Suzzi
R
R
Terlizzi
F
F
Canel
C
C
Cernetti
L
L
Celegon
D000368:Aged; D004176:Dipyridamole; D004452:Echocardiography / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D005080:Exercise Test / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000000981:diagnostic imaging*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D014665:Vasodilator Agents
D014665:Vasodilator Agents; D004176:Dipyridamole