title: Prevalence and prognostic significance of silent myocardial ischaemia detected by exercise test and continuous ECG monitoring after acute myocardial infarction.
abstract: The incidence and prognostic significance of silent myocardial ischaemia in 165 patients who survived a first acute myocardial infarction were assessed by means of maximal exercise stress test and 24 h continuous ECG monitoring performed before discharge. During the 1 year follow-up period 10 cardiac deaths occurred; moreover seven patients suffered a fatal myocardial re-infarction and 14 developed unstable angina. Cardiac death occurred in five of 40 patients (12.5%) with ST segment depression on stress test by in only three of 117 (2.6%) without ST segment changes (P less than 0.01). One-hundred-and-three of 117 patients (88.0%) without angina or ST segment depression on stress testing survived 1 year without cardiac events, compared with 24 of 40 patients (60.0%) with ST segment depression whether or not associated with angina (P less than 0.001). Cardiac death occurred in five of 25 patients (20.0%) with ST segment depression on continuous ECG monitoring, compared with five of 140 (3.6%) without (P less than 0.01). One-hundred-and-seventeen out of 140 patients (83.6%) without angina or ST segment depression survived 1 year follow-up without cardiac events, compared with 13 of 25 (52.0%) with ST segment depression with or without angina (P less than 0.01). Classifying patients in a 2 x 5 contingency table according to the occurrence of ST segment depression on exercise testing and/or ECG ambulatory monitoring, the Yates corrected chi-square test showed a significant pattern when cardiac deaths and cardiac events were considered together (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Institute of Internal Medicine, 2nd School of Medicine, Naples, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Bonaduce
authors.forename: M
authors.initials: M
authors.lastname: Petretta
authors.forename: T
authors.initials: T
authors.lastname: Lanzillo
authors.forename: G
authors.initials: G
authors.lastname: Vitagliano
authors.forename: V
authors.initials: V
authors.lastname: Bianchi
authors.forename: G
authors.initials: G
authors.lastname: Conforti
authors.forename: G
authors.initials: G
authors.lastname: Morgano
authors.forename: P
authors.initials: P
authors.lastname: Arrichiello
mesh_terms: D000328:Adult; D000368:Aged; D000789:Angina, Unstable / Q000175:diagnosis / Q000401:mortality; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000401:mortality; D003327:Coronary Disease / Q000175:diagnosis* / Q000401:mortality; D015716:Electrocardiography, Ambulatory; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality; D015996:Survival Rate