Increased incidence of silent ischemia after acute myocardial infarction.
OBJECTIVE
To determine the incidence of angina pectoris during induced myocardial ischemia in patients who have had thrombolytic therapy for acute myocardial infarction in comparison with patients with angina pectoris.


METHODS
During percutaneous transluminal coronary angioplasty, both study groups had coronary artery occlusion by the balloon dilatation catheter for 5 minutes.


METHODS
A tertiary, cardiology referral center.


METHODS
Twenty-five patients with angina pectoris who were undergoing angioplasty were compared with 30 patients having angioplasty 2 days after thrombolytic therapy for acute myocardial infarction.


RESULTS
Development of angina pectoris during balloon occlusion of the coronary artery was the primary end point; the ischemic response and muscle viability were assessed using both surface and intracoronary electrocardiograms and pulmonary artery wedge pressure.


RESULTS
During balloon occlusion 16 (64%) of 25 patients in the angina pectoris group developed angina. In contrast, nine (30%) of 30 patients in the thrombolysis group had angina pectoris during balloon occlusion of the infarct artery (P less than .01). The electrocardiographic response to ischemia and changes in pulmonary wedge pressure were similar in the two study groups.


CONCLUSIONS
After thrombolytic therapy for myocardial infarction, silent ischemia may be the rule rather than the exception.
Taylor
G J
GJ
Prairie Cardiovascular Center, Springfield, Ill.
Katholi
R E
RE
Womack
K
K
Moses
H W
HW
Woods
W T
WT
D000787:Angina Pectoris / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D003327:Coronary Disease / Q000503:physiopathology*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy; D011669:Pulmonary Wedge Pressure; D015912:Thrombolytic Therapy