Myocardial viability assessed by dobutamine stress echocardiography predicts reduced mortality early after acute myocardial infarction: determining the risk of events after myocardial infarction (DREAM) study.
OBJECTIVE
To establish further the role of dobutamine stress echocardiography (DSE) in prognostication of outcome early after acute myocardial infarction (AMI) METHODS: Consecutive patients presenting with AMI were screened for inclusion into the study. 212 stable consenting patients underwent DSE a mean (SD) of 4.8 (1.5) days after AMI. Patients were then followed up for 803 (297) days.


RESULTS
The mean (SD) resting systolic wall thickening index (SWTI) was 1.6 (0.4), 44% patients had evidence of viability at low dose, and 38% had evidence of ischaemia. During the follow up period 27 (13%) patients died and 16 (8%) had a non-fatal AMI. Independent predictors of both mortality and combined mortality and non-fatal AMI were age (hazard ratio (HR) 1.04/year, p = 0.01, and HR 1.03/year, p = 0.04, respectively) and SWTI at low dose (HR 3.6, p < 0.01, and HR 2.5, p = 0.02, respectively). Low dose DSE provided incremental information over clinical and resting left ventricular function data for predicting death and non-fatal AMI. For patients who were not revascularised SWTI at peak dose dobutamine was the only independent predictor of mortality.


CONCLUSIONS
DSE is a powerful predictor of outcome in stable survivors of AMI. The presence of myocardial viability has a positive impact on survival.
Swinburn
J M A
JM
Department of Cardiovascular Medicine, Northwick Park Hospital, Harrow, Middlesex, UK.
Senior
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D025401:Echocardiography, Stress / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis