BACKGROUND We assessed the value of dobutamine stress echocardiography (DSE) in predicting cardiac events in patients with acute or chronic myocardial infarction (MI), and we studied the association between DSE and these events. RESULTS Two hundred sixty-six patients (mean [+/-SD] age 65.3 +/- 11.4 years) with acute (n = 139) or chronic (n = 127) MI were recruited from March 1995 through April 1997. Both groups underwent DSE and were followed up for an average of 14.1 +/- 8.0 months. DSE was positive in 111 (79.9%) patients with acute MI and 65 (51.2%) patients with chronic MI (P <.0001 ). Positive DSE results were associated with a higher rate of all cardiac events (cardiac mortality rate, reinfarction, and unstable angina) than negative DSE results in both patients with acute MI and patients with chronic MI (44 in 111 patients vs 6 in 28 patients, P =.052, and 31 in 65 patients vs 10 in 62 patients, P <.0001, respectively). Among patients with acute MI, the positive and negative predictive values of DSE for all cardiac events were 39.6% (95% confidence interval [CI] 30.5% to 48. 7%) and 78.6% (95% CI 63.4% to 93.8%), respectively. In chronic MI, the positive and negative predictive values were 47.7% (95% CI 35.5% to 59.8%) and 83.9% (95% CI 74.7% to 93.0%), respectively. In both acute (P =.03) and chronic (P <.0001 ) MI, positive DSE findings were independent predictors of all cardiac events. CONCLUSIONS DSE is useful for predicting cardiac events. A positive finding on DSE is an independent predictor of cardiac events after both acute and chronic MI, whereas a negative DSE result predicts a low likelihood of subsequent cardiac events.