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HOW IMPORTANT IS SILENT ISCHEMIA IN LOW-RISK PATIENTS.
The availability of ECG monitoring devices that can detect asymptomatic myocardial ischemia has raised questions about the importance of this common finding. These researchers studied the prognostic significance of ST- segment changes detected during daily activities in 116 patients with angiographically-proven coronary artery disease who were asymptomatic or had only mild symptoms.
The study excluded patients with left main disease, 3- vessel disease with resting left-ventricular dysfunction or exercise-induced ischemia, or 2-vessel disease with both LV dysfunction and inducible ischemia. Transient ischemia was detected in 45 of the 116 patients during 48 hours of ambulatory ECG monitoring. During an average follow-up of 29 months, there were 8 cardiac events, 7 of them in patients without silent ischemia. Multivariate analyses did not reveal any relation between ambulatory ECG findings and patient outcome.
These data suggest that patients who appear to be at low risk for cardiac complications on the basis of stress testing and other clinical findings can be managed safely without monitoring for silent ischemia.
— THL
Published in Journal Watch General Medicine March 9, 1993
Citation(s):
Quyyumi AA et al. Prognostic implications of myocardial ischemia during daily life in low risk patients with coronary artery disease. J Am Coll Cardiol 1993 Mar 1 21 700-708.
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