title: Comparison of silent and symptomatic ischemia during exercise testing in men.
abstract: OBJECTIVE
  To compare angina and ST-segment depression during exercise testing, as markers for coronary artery disease.
  
  
  METHODS
  Retrospective analysis of exercise test responses and cardiac catheterization results.
  
  
  METHODS
  A U.S. Veterans Affairs medical center.
  
  
  METHODS
  Four hundred and sixteen men who were referred for the evaluation of symptoms, postmyocardial infarction testing, or both. Two hundred patients had no clinical or electrocardiographic evidence of previous myocardial infarction, whereas 216 were survivors of a previous myocardial infarction.
  
  
  METHODS
  All patients did a standard exercise test and had diagnostic coronary angiography with ventriculography within an average of 32 days (range, 0 to 90 days) of their exercise test.
  
  
  RESULTS
  Two hundred patients without a previous myocardial infarction were divided into four groups: the no ischemia group had 80 patients; the angina pectoris only group had 23 patients; the silent ischemia group had 40 patients; and the ST-segment depression and angina pectoris group had 57 patients. In patients without a previous myocardial infarction, exercise-induced ST-segment depression was a better marker than exercise-induced angina for the presence of any coronary artery disease (P less than 0.005). Patients with symptomatic exercise-induced ischemia had a higher prevalence of severe coronary artery disease than did those with only silent ischemia (30% compared with 20%; 95% CI, - 7.3% to 27.0%; P = 0.005). For the 216 survivors of a myocardial infarction, divided into the same four groups, ST-segment depression again was a better marker for the presence of severe coronary artery disease compared with angina alone (P = 0.08). The prevalence rates of severe coronary artery disease in the no ischemia plus myocardial infarction group, the angina pectoris only plus myocardial infarction group, the silent ischemia plus myocardial infarction group, and the ST-segment depression and angina pectoris plus myocardial infarction group were 10%, 9%, 23%, and 32%, respectively (P less than 0.01).
  
  
  CONCLUSIONS
  Exercise-induced ST-segment depression is a better marker for coronary artery disease than is exercise-induced angina. Symptomatic ischemia during the exercise test is a better marker for severe coronary artery disease than is silent ischemia.
authors.affiliation: Long Beach Veterans Affairs Medical Center, California.
authors.forename: C P
authors.initials: CP
authors.lastname: Miranda
authors.forename: K G
authors.initials: KG
authors.lastname: Lehmann
authors.forename: B
authors.initials: B
authors.lastname: Lachterman
authors.forename: E M
authors.initials: EM
authors.lastname: Coodley
authors.forename: V F
authors.initials: VF
authors.lastname: Froelicher
mesh_terms: D000787:Angina Pectoris / Q000503:physiopathology*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis*; D004562:Electrocardiography; D005080:Exercise Test; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013223:Statistics as Topic