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SILENT ISCHEMIA IS NOT IMPORTANT IN STABLE PATIENTS.

Silent myocardial ischemia can be detected with ambulatory monitoring, but whether asymptomatic ischemia warrants treatment is controversial. This study assessed the value of noninvasive tests in predicting coronary complications.

The 936 patients were clinically stable 1 to 6 months after hospitalization for acute infarction or unstable angina. One third had undergone angioplasty during the acute hospitalization, and another 6 percent had angioplasty sometime between discharge and study enrollment. The patients underwent rest, ambulatory, and exercise electrocardiography and stress thallium scintigraphy and were followed at 4-month intervals for a mean of 23 months.

In a multivariate analysis, ST-segment depression on the rest ECG was associated with a 50 percent increased risk for subsequent cardiac death, nonfatal infarction, or unstable angina. Ischemia on ambulatory ECG was not associated with coronary events. Reversible thallium defects and exercise- induced ST depression with reduced exercise duration correlated with coronary complications, but these indicators were found in less than 6 percent of patients who had cardiac events.

These data show that a finding of silent ischemia has limited use in stratifying the risk for subsequent coronary events in patients who are clinically stable one or more months after an acute event. A major limitation of this study is that it enrolled patients 1 to 6 months after infarction or unstable angina, whereas many complications occur within the first month.

— THL

Published in Journal Watch General Medicine May 18, 1993

Citation(s):

Moss AJ et al. Detection and significance of myocardial ischemia in stable patients after recovery from an acute coronary event. JAMA 1993 May 12 269 2379-2385.

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