title: Prognostic value of total ischemic burden in patients with stable ischemic heart disease.
abstract: Patients with stable coronary artery disease commonly have transient myocardial ischemia with or without experiencing angina, but the prognostic implications of this "total ischemic burden" is still a matter of debate. We studied 112 consecutive patients with coronary artery disease, normal left ventricular function at rest and exercise-induced myocardial ischemia, a 24-hour ambulatory EKG was performed after drug withdrawal. The mean exercise duration was 572 +/- 192 seconds, with an ischemic threshold (ST depression = 1 mm) of 390 +/- 190 seconds). By Holter monitoring 30 patients had no ischemia and 82 (73%) had a total of 332 episodes of ST segment changes, the majority of which were asymptomatic (242/332, 73%). Among 82 patients with transient myocardial ischemia, 44 (54%) had only asymptomatic episodes. Nine patients (11%) complained of angina coincident to ST changes. Twenty-nine patients (35%) had both painful and painless ST segment alterations. All patients were prospectively followed-up while on conventional medical therapy. During a mean follow up of 25 +/- 10 months cardiac events occurred in 31 patients; there were 5 cardiac deaths, 3 non-fatal myocardial infarctions, 2 hospitalization for unstable angina and 21 revascularization procedures (PTCA or CABG). By multivariate analysis the number of stenotic vessels on coronary angiography was predictive of the events during the follow-up (p = 0.03), while other demographic, clinical, ergometric and angiographic variables were not influential. Event-free survival was similar for all subsets of transient myocardial ischemia (silent, symptomatic, or none).(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Centro Cardiovascolare, Ospedale Maggiore, Trieste.
authors.forename: C
authors.initials: C
authors.lastname: Pandullo
authors.forename: S
authors.initials: S
authors.lastname: Scardi
authors.forename: R
authors.initials: R
authors.lastname: Cesanelli
authors.forename: B
authors.initials: B
authors.lastname: Zingone
authors.forename: C
authors.initials: C
authors.lastname: Negro
authors.forename: M
authors.initials: M
authors.lastname: Bovenzi
mesh_terms: D000368:Aged; D003327:Coronary Disease / Q000503:physiopathology*; D015716:Electrocardiography, Ambulatory; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D005082:Physical Exertion / Q000502:physiology*; D011379:Prognosis