Circulation, Vol 83, 1598-1604, Copyright © 1991 by American Heart Association
AC Yeung, J Barry, J Orav, E Bonassin, KE Raby and AP Selwyn
BACKGROUND. Ischemia on ambulatory electrocardiographic monitoring has been
shown to adversely affect short-term prognoses in patients with unstable
angina, after myocardial infarction, and with chronic stable angina.
METHODS AND RESULTS. In this long-term study, we followed 138 patients
(mean age, 59 +/- 9 years) with chronic stable angina and positive exercise
tests for cardiac events (e.g. death, myocardial infarction, percutaneous
transluminal coronary angioplasty, or coronary artery bypass graft
surgery). In 105 patients, ambulatory electrocardiographic monitoring was
performed after all antianginal medication was withheld for 48 hours. In 26
patients, the diagnostic tests were repeated while on their usual
medication. In addition to the 105 patients, 33 patients had their
monitoring performed only while on their usual medication. During 37 +/- 17
months of follow-up, there were nine deaths, nine myocardial infarctions,
and 35 revascularization procedures. In patients monitored off medication,
Cox survival analysis showed that the occurrence of ischemia on
electrocardiographic monitoring was the most significant predictor of death
and myocardial infarction in the subsequent 2 years (p = 0.02) and all
adverse events for 5 years (p = 0.009). Patients who were monitored on
medication and did not have ischemia (n = 18) appeared to have more adverse
events than patients who had no ischemia while being monitored off
medication (n = 43). CONCLUSIONS. Asymptomatic ischemia on ambulatory
electrocardiographic monitoring in patients with stable angina predicts
death and myocardial infarction for 2 years and all adverse events for 5
years. Monitoring performed while on medication may show no ischemia;
however, this may not indicate low risk of future coronary events.
ARTICLES
Effects of asymptomatic ischemia on long-term prognosis in chronic stable coronary disease
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115.
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