Document Detail

Age-related determinants of outcome after acute myocardial infarction: a dobutamine-atropine stress echocardiographic study.
MedLine Citation:
PMID:  12133010     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: To investigate the cause of worse survival in older patients after myocardial infarction (MI). DESIGN: Prospective 18-month and longer follow-up study of a cohort of 167 patients (mean age +/- standard deviation 58 +/- 12, including 71 aged >or=65) with acute MI for cardiac events, defined as cardiac death, recurrent MI, or resuscitated ventricular tachycardia or fibrillation (VT/VF). SETTING: Milwaukee County Medical Complex and the Zablocki Veterans Affairs Medical Center, Milwaukee, WI. PARTICIPANTS: One hundred sixty-seven patients who underwent dobutamine-atropine stress echocardiography (DASE) in the first week (2-7 days) after acute MI and were medically managed. MEASUREMENTS: Comparison of event rates in older (>or=65 years) and younger (<65 years) patients and of clinical, resting echocardiographic, DASE, and angiographic findings in patients with and without events. Coronary angiography was performed in 141. RESULTS: Older and younger patients tolerated DASE well. During follow-up, there were 29 cardiac events (cardiac death in 17, nonfatal MI in 10, and VT/VF in 2). Events were more common in older patients (26% vs 12%, P <.05), especially death (19% vs 5%, P <.05). Scar size in the infarct zone by DASE was larger (4.0 +/- 2.8 vs 3.0 +/- 2.7 segments, P <.05) and remote wall motion abnormalities more common (47 vs 29%, P <.05) in older patients. Univariate determinants of outcome (P <.05) in older patients were diabetes mellitus; remote wall motion abnormalities; angiographic multivessel disease; scar size; ejection fraction; and resting, low-, and peak-dose wall motion score. Univariate determinants in younger patients were similar, but diabetes mellitus was not. Multivariate analysis revealed that remote wall motion abnormalities and scar size by DASE were independently predictive of outcome in older and younger patients and diabetes mellitus only in older patients. Low- and peak-dose DASE data enhanced (P <.01) the prediction of outcome in all patients with acute MI relative to clinical data and resting echocardiography. CONCLUSION: DASE was more predictive of outcome than clinical data and resting echocardiography in both age groups. Scar size and remote wall motion abnormalities were the primary determinants of outcome irrespective of age. The worse prognosis of older patients correlated with diabetes mellitus, greater scar size, and higher incidence of remote inducible ischemia.
Steven Smart; Kiran Sagar; Donald Tresch
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American Geriatrics Society     Volume:  50     ISSN:  0002-8614     ISO Abbreviation:  J Am Geriatr Soc     Publication Date:  2002 Jul 
Date Detail:
Created Date:  2002-07-22     Completed Date:  2002-08-15     Revised Date:  2008-03-10    
Medline Journal Info:
Nlm Unique ID:  7503062     Medline TA:  J Am Geriatr Soc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1176-85     Citation Subset:  IM    
Division of Cardiovascular Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin 54601, USA.
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MeSH Terms
Age Factors
Aged, 80 and over
Analysis of Variance
Anti-Arrhythmia Agents / diagnostic use
Atropine / diagnostic use
Cardiotonic Agents / diagnostic use
Chi-Square Distribution
Coronary Angiography
Dobutamine / diagnostic use
Echocardiography / methods*
Exercise Test
Follow-Up Studies
Logistic Models
Middle Aged
Myocardial Infarction / physiopathology*,  ultrasonography*
Predictive Value of Tests
Prospective Studies
ROC Curve
Risk Assessment
Survival Analysis
Reg. No./Substance:
0/Anti-Arrhythmia Agents; 0/Cardiotonic Agents; 34368-04-2/Dobutamine; 51-55-8/Atropine

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