Usefulness of ambulatory silent myocardial ischemia added to the prognostic value of exercise test parameters in predicting risk of cardiac death in patients with stable angina pectoris and exercise-induced myocardial ischemia.
The prognostic significance of ambulatory silent ischemia detected by Holter monitoring during daily life was prospectively evaluated and compared with several exercise test parameters in 86 patients with stable angina and positive exercise tests. Forty-seven patients (group 1) had no evidence of ischemia and 39 (group 2) had 1 or more episodes of silent ischemia during the monitoring period. During mean follow-up of 24 +/- 8 months there were only 2 cardiac deaths (nonsudden) in group 1 (4% mortality) compared with 9 (3 sudden and 6 nonsudden) in group 2 (23% mortality). Kaplan-Meier actuarial analysis revealed worse survival (p less than 0.008) for patients in group 2. The Cox regression analysis of clinical variables, electrocardiographic and exercise parameters, angiographic data and Holter monitoring results revealed silent ischemia during daily life as the most powerful predictor of cardiac mortality (p = 0.003). These results demonstrate that in patients with chronic stable angina and abnormal exercise tests, ambulatory ischemia detected by Holter monitoring provides significant additional prognostic information to that derived from evaluation of exercise test parameters alone.
Deedwania
P C
PC
Department of Medicine, Veterans Affairs Medical Center, Fresno, California 93703.
Carbajal
E V
EV
D000206:Actuarial Analysis; D000787:Angina Pectoris / Q000401:mortality*; D003327:Coronary Disease / Q000401:mortality*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D015716:Electrocardiography, Ambulatory; D005080:Exercise Test; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D013997:Time Factors