The relative value of exercise-electrocardiography and dipyridamole stress echocardiography for risk stratification early after uncomplicated myocardial infarction. The EPIC (Echo Persantine International Cooperative) Study Group.

Abstract

BACKGROUND:

Rational prognostic algorithm should be developed considering the logical progression of the information as it becomes available to the physician, with clinical data first, ECG data second and stress imaging data last. The aim of the present study was to assess in a clinically realistic fashion the relative prognostic value of exercise electrocardiography test (EET) and dipyridamole-echocardiography test (DET) early after first acute uncomplicated myocardial infarction.

METHODS AND RESULTS:

Five hundred and forty-seven in-hospital patients (age = 56 +/- 9 years) with recent clinically uncomplicated first myocardial infarction, baseline echocardiographic findings of satisfactory quality, interpretable ECG and capability to exercise underwent a resting 2D echocardiogram, a DET and an EET at a mean of 10 days from the infarction and were followed up for 16.2 +/- 11 months. During the follow-up, there were 17 cardiac deaths, 19 non-fatal myocardial infarctions and 49 unstable angina. When cardiac death was considered as the only significant event, with multivariate analysis, peak dipyridamole Wall Motion Score Index was the only significant predictor (chi 2 = 5.66; p = 0.013; relative risk estimate = 4.7; confidence intervals = 1.35-16.08). In presence of a negative exercise electrocardiography test for both chest pain and electrocardiographic criteria, the death rate was 2%.

CONCLUSION:

DET provides stronger information in comparison with historical and EET variables. However, a negative maximal EET is sufficient to identify a very low risk subset in whom additional testing may not be warranted.

• Authors: E Picano, R Sicari, M Baroni, B Del Negro, C Michelassi, S Pirelli, G Chiarandà, M Previtali, G Seveso, N Gandolfo, C Vassalle, F Margaria, O Magaia, F Bianchi, G Minardi, P Landi, M Raciti, S Severi
• Journal: Giornale italiano di cardiologia (G Ital Cardiol) Vol. 27 Issue 1 Pg. 32-9 (Jan 1997) ISSN: 0046-5968 [Print] Italy
• PMID: 9199941 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)

Chemical References

• Vasodilator Agents
• Dipyridamole

Topics

• Cause of Death
• Dipyridamole
• Echocardiography
• Electrocardiography
• Exercise Test
• Female
• Follow-Up Studies
• Heart Diseases (physiopathology)
• Humans
• Male
• Middle Aged
• Multivariate Analysis
• Myocardial Infarction (diagnosis, diagnostic imaging, physiopathology)
• Prognosis
• Risk
• Vasodilator Agents