Study objectives: To assess the prognostic value of
dobutamine-atropine stress echocardiography (DSE) after uncomplicated
acute myocardial infarction (AMI) in elderly patients.
Design: We analyzed 59 consecutive patients (42 men) aged≥
70 years (mean ± SD age, 75 ± 4 years) who underwent DSE
within 10 days after uncomplicated AMI. DSE was carried out following
the standard protocol. Five myocardial responses were considered: (1)
negative, (2) sustained improvement of contractility, (3) biphasic
response (initial improvement followed by worsening), (4) worsening of
contractility in the infarcted area, and (5) worsening at a distance.
Results: Mean follow-up duration was 13 ± 8 months.
Twenty-one patients had an event: cardiac death (n = 5), myocardial
infarction (n = 1), heart failure (n = 1), unstable angina
(n = 10), and revascularization (n = 4). Clinical and stress
echocardiographic variables previously related to adverse prognosis
were entered in Cox regression analysis, and the predictors of impaired
outcome were inducible ischemia during DSE (hazard ratio [HR], 2.97;
95% confidence interval [CI], 1.77 to 4.99; p < 0.001) and
resting wall motion score index (WMSI) > 1.6 (HR, 1.68; 95% CI, 1.02
to 2.77; p = 0.04). After excluding revascularization procedures and
considering only spontaneous events, the following predictors were
found: ischemia during DSE (HR, 2.95; 95% CI, 2.78 to 3.12;
p < 0.001) and resting WMSI > 1.6 (HR, 2.53; 95% CI, 1.30 to
4.93; p = 0.006).
Conclusions: Inducible ischemia
during DSE within 10 days after uncomplicated AMI predicts an impaired
outcome in the elderly.