Study objective: To determine whether the prognostic
value of dobutamine stress echocardiography (DSE) performed early after
acute myocardial infarction (AMI) is as high in diabetic patients as in
Design: Inception cohort
Setting: Tertiary cardiac referral center.
Patients and interventions: Three hundred thirty-eight
patients (116 diabetic and 222 nondiabetic) who underwent DSE after AMI
were followed up for cardiac events.
results: Outcome events were as follows: “hard” events
consisted of cardiac death and nonfatal reinfarction, while “all
events” included hard events and unstable angina. The mean follow-up
duration was 21 ± 9 months. DSE results were positive in 69 diabetic
patients (59.5%) and 129 nondiabetic patients (58.1%; p = 0.817).
During the follow-up period, there were 25 cardiac deaths, 16 cases of
nonfatal reinfarction, and 55 cases of unstable angina. The
Kaplan-Meier life table showed that a positive DSE result was
associated with a lower event-free survival rate in nondiabetic but not
in diabetic patients in terms of hard and all events. By multivariate
analysis, a positive DSE result was the strongest independent predictor
of future cardiac events in nondiabetic patients. However, in
diabetics, a shorter dobutamine time, rather than a positive DSE
result, independently predicted cardiac events.
Conclusions: Our preliminary data suggest that different
DSE variables should be considered when assessing the likelihood of
future events in diabetic and nondiabetic patients after AMI. The
observation of shorter dobutamine time, instead of DSE positivity, has
a higher prognostic value in diabetics. In diabetic patients, the only
significant role of DSE positivity is for predicting future unstable
angina; however, its predictive value is not as good as in nondiabetic