OBJECTIVE To assess the prognostic value of dobutamine-atropine stress echocardiography (DSE) after uncomplicated acute myocardial infarction (AMI) in elderly patients. METHODS We analyzed 59 consecutive patients (42 men) aged > or = 70 years (mean +/- SD age, 75 +/- 4 years) who underwent DSE within 10 days after uncomplicated AMI. DSE was carried out following the standard protocol. Five myocardial responses were considered: (1) negative, (2) sustained improvement of contractility, (3) biphasic response (initial improvement followed by worsening), (4) worsening of contractility in the infarcted area, and (5) worsening at a distance. RESULTS Mean follow-up duration was 13 +/- 8 months. Twenty-one patients had an event: cardiac death (n = 5), myocardial infarction (n = 1), heart failure (n = 1), unstable angina (n = 10), and revascularization (n = 4). Clinical and stress echocardiographic variables previously related to adverse prognosis were entered in Cox regression analysis, and the predictors of impaired outcome were inducible ischemia during DSE (hazard ratio [HR], 2.97; 95% confidence interval [CI], 1.77 to 4.99; p < 0.001) and resting wall motion score index (WMSI) > 1.6 (HR, 1.68; 95% CI, 1.02 to 2.77; p = 0.04). After excluding revascularization procedures and considering only spontaneous events, the following predictors were found: ischemia during DSE (HR, 2.95; 95% CI, 2.78 to 3.12; p < 0.001) and resting WMSI > 1.6 (HR, 2.53; 95% CI, 1.30 to 4.93; p = 0.006). CONCLUSIONS Inducible ischemia during DSE within 10 days after uncomplicated AMI predicts an impaired outcome in the elderly.