This study was conducted to assess the feasibility, safety and prognostic value of
dipyridamole echocardiography in elderly patients recovering from an uncomplicated acute
myocardial infarction in a subset analysis performed on the patients entered in the subproject "residual
ischemia" of the Echo
Persantine Italian Cooperative Study (EPIC).
BACKGROUND: In a subgroup analysis of the Echo
Persantine Italian Cooperative Study (EPIC), we assessed the value of
dipyridamole echocardiography in predicting
cardiac events in 190 elderly (> or = 65 years) patients (age 68.4 +/- 3.3 years, range 65 to 78; 147 men and 43 women) evaluated early (mean 10 days) after uncomplicated acute
myocardial infarction and followed up for 14 +/- 9.8 months.
RESULTS: There was no major side effect during
dipyridamole echocardiography. A positive test result occurred in 85 patients (44.7%). During follow-up, there were 62 events (14 cardiac deaths, 7 nonfatal reinfarctions, 21 cases of class III or IV angina and 20 revascularization procedures). Of these 62 events, 44 occurred among 85 patients with positive
dipyridamole echocardiography and 18 among 105 patients with negative
dipyridamole echocardiography (52% vs. 17%, p < 0.001). Spontaneous events (death, reinfarction, angina) occurred in 31 patients with positive and in 11 with negative
dipyridamole echocardiography (36% vs. 10%, p < 0.001). Hard events (
myocardial infarction or death) occurred in 14 patients with positive and 7 with negative
dipyridamole echocardiography (16% vs. 6%, p < 0.05). Death occurred in 11 patients with positive and in 3 with negative
dipyridamole echocardiography (13% vs. 3%, p < 0.01). The positive predictive value of positive
dipyridamole echocardiography and negative predictive value of negative
dipyridamole echocardiography as related to the occurrence of all events in the follow-up period (death, reinfarction, angina, revascularization procedures) were 52% and 83%, respectively. The relative risk (that is, the relative risk of occurrence of future
cardiac events in the group with positive
dipyridamole echocardiography compared with that in those with negative
dipyridamole echocardiography) was 3 for all events and 4.4 for death.
CONCLUSIONS: