Sudden death and silent myocardial ischemia.
Recent research indicates that silent myocardial ischemia may play a role in sudden cardiac death. To what extent treatment can reduce occurrence of silent ischemia remains to be assessed. Three classes of silent ischemia patients are identified: type 1--totally asymptomatic; type 2--post myocardial infarction; and type 3--noninfarcted with both silent ischemia and angina. An index of prognostic risk (PR), showing the percent of adverse events attributable to silent ischemia, is calculated to measure the potential impact of successful treatment of silent ischemia on population mortality. Type 1 individuals' PR is estimated at a low 3.8%, suggesting that screening the general asymptomatic population would be unproductive. Type 2 patients exhibit an 80% PR. We lack the empirical information to estimate type 3 patients' PR, but silent ischemia is a recognized adverse prognostic factor in the subgroup exhibiting unstable angina. These results suggest that successful treatment of silent ischemia might favorably influence coronary artery disease patient outcomes.
Sheps
D S
DS
Division of Cardiology, University of North Carolina, School of Medicine, Chapel Hill 27599.
Heiss
G
G
D003327:Coronary Disease / Q000145:classification / Q000175:diagnosis / Q000503:physiopathology*; D003645:Death, Sudden / Q000209:etiology*; D006801:Humans; D010146:Pain / Q000503:physiopathology; D011379:Prognosis