[The usefulness of the echo-dipyridamole and exercise tests in risk stratification in patients with acute uncomplicated myocardial infarct after systemic thrombolysis].

We studied 142 patients (121 males, 21 females) survivors of a first non complicated acute myocardial infarction (AMI) treated with thrombolytic therapy between March 1988 and December 1989. Dipyridamole echocardiography test (DET, 67 patients) and exercise electrocardiography test (EET, 104 patients) were performed to assess sensitivity and specificity in identifying patients at risk for an unfavorable clinical outcome and subsequent cardiac events: 67 patients underwent coronary arteriography within 4 weeks after AMI. DET positivity was related to the detection of a new transient asynergy of contraction either in infarct area or in remote zones. The mean follow-up period was 12 months (range 4-20). Clinical follow-up end-points of the study included death, re-AMI, angina. Sensitivity and specificity of EET and DET were 75 and 68%, 53 and 71% respectively. If EET plus DET were considered, sensitivity was 81% and specificity 60%. The fairly good DET sensitivity and specificity could be partially explained by some stunned myocardium exhibiting prolonged contractile dysfunction despite myocardial reperfusion. EET sensitivity and specificity is comparable to previous observations in AMI not treated with thrombolytic therapy. DET seems to be a useful and safe test in prognostic evaluation of asymptomatic patients after thrombolysed AMI, but its value is improved in association with EET.