Author + information
- Received October 21, 1994
- Revision received May 9, 1995
- Accepted May 25, 1995
- Published online October 1, 1995.
- Eugenio Picano, MD*,
- Alessandro Pingitore, MD,
- Rosa Sicari, MD,
- Giovanni Minardi, MD,
- Nicola Gandolfo, MD,
- Giovanni Seveso, MD,
- Francesco Chiarella, MD,
- Leonardo Bolognese, MD,
- Giacomo Chiarandà, MD,
- Maria Grazia Sclavo, MD,
- Mario Previtali, MD,
- Franca Margaria, MD,
- Ornella Magaia, MD,
- Federico Bianchi, MD,
- Salvatore Pirelli, MD,
- Silva Severi, MD,
- Mauro Raciti,
- Patrizia Landi,
- Cristina Vassalle, MSc,
- Maria José Bento de Sousa, MD,
- Luis Felipe de Moura Duarte, MD,
- on Behalf of the Echo Persantine International Cooperative (EPIC) Study Group
- ↵*Address for correspondence: Dr. Eugenio Picano, Istituto di Fisiologia Clinica, CNR, Via Paolo Savi 8. 56100 Pisa, Italy.
Objectives. This study sought to assess the value of dipyridamole echocardiography in predicting reinfarction in patients evaluated early after uncomplicated acute myocardial infarction.
Background. The identification of future nonfatal reinfarction seems an elusive target for physiologic testing. However, a large sample population is needed to detect minor differences in phenomena with a low event rate.
Methods. We assessed the value of dipyridamole echocardiography in predicting reinfarction in 1,080 patients (mean [±SD] age 56 ± 9 years; 926 men, 154 women) evaluated early (10 ± 5 days) after uncomplicated acute myocardial infarction and followed up for 14 ± 10 months.
Results. Submaximal studies due to limiting side effects occurred in 14 patients (1.3%); these test results were included in the analysis. Results of dipyridamole echocardiography were positive in 475 patients (44%). During follow-up, there were 50 reinfarctions: 45 nonfatal, 5 fatal (followed by cardiac death ≤4 days after reinfarction). Reinfarction (either nonfatal or fatal) occurred in 30 patients with positive and 20 with negative results (6.3% vs. 3.3%, p < 0.01). Nonfatal reinfarction occurred in 25 patients with positive and 20 with negative results (5% vs. 3.3%, p < 0.05). Reinfarction was fatal in 5 of 30 patients with positive and in none of 20 with negative results (16.6% vs. 0%, p = 0.07). The relative risk of reinfarction was 1.9.
Conclusions. Dipyridamole echocardiographic positivity identifies patients evaluated early after uncomplicated acute myocardial infarction at higher risk of reinfarction, especially fatal reinfarction.
A complete list of contributors to the EPIC study appears in reference 3.
- Received October 21, 1994.
- Revision received May 9, 1995.
- Accepted May 25, 1995.
- American College of Cardiology