Sensitivity and specificity of dobutamine-electrocardiography test to detect multivessel disease after acute myocardial infarction

The value of dobutamine-electrocardiography (ECG) as a stress test to detect multivessel coronary disease after non-complicated acute myocardial infarction (AMI) was assessed in 75 patients before hospital discharge. Dobutamine-ECG test (dose of 5, 10, 15 and 20 micrograms kg-1 min-1 every 5 min) was performed 5 to 12 days after the beginning of the symptoms of AMI, and coronary angiography within the first month. Heart rate increased from 71 +/- 12 to 106 +/- 17 beats min-1, and systolic blood pressure from 111 +/- 15 to 139 +/- 20 mmHg. Dobutamine test was negative (neither anginal pain, nor ST-segment depression) in 33 patients and positive in 42. The angiographic study showed the presence of non-significant (less than or equal to 50%) coronary lesions in 11 patients, one-vessel disease in 33, two-vessel disease in 18 and three-vessel disease in 13 patients. Sensitivity of dobutamine-ECG test to detect multivessel (two- or three-vessel) disease was 84%, specificity 64%, predictive value of a positive test: 62%, predictive value of a negative test: 85%, and diagnostic efficiency: 72%. In conclusion dobutamine-ECG is a highly sensitive test to diagnose multivessel disease in patients with non-complicated AMI. The specificity is lower, probably due to detection of peri-infarction ischaemia in cases of one-vessel disease.