title: Prognostic significance of silent myocardial ischemia after a first uncomplicated myocardial infarction.
abstract: Forty asymptomatic patients were studied after a first uncomplicated myocardial infarction. They were 36 men and 4 women, with a mean age of 52.6 yr; the location of myocardial infarction was in the anterior wall in 18 (45%) patients and in the inferior wall in 22 (55%). The patients were submitted to: (1) 48-h Holter monitoring, during the 2nd and 8th weeks after the acute event; (2) exercise testing during the same periods; (3) cardiac catheterization and coronary arteriography. Patients with clinical conditions associated with cardiac rhythm disturbances or repolarization abnormalities were excluded. The electrocardiographic methods identified 11 (27.5%) patients with silent myocardial ischemia. Patients with and without silent ischemia were similar in relation to sex, age, coronary risk factors, arrhythmias, left ventricular function and follow-up. Patients with silent ischemia had more inferior wall myocardial infarctions, but the difference was not statistically significant. Patients with silent ischemia had significantly more extensive coronary artery disease (45.5% multivessel disease) when compared to those without ischemia (14.8% multivessel disease) (p < 0.05). After a 2-yr follow-up, 4 (36.4%) patients with and 1 (3.4%) without silent ischemia had a coronary event (p < 0.05). Kaplan-Meier analysis demonstrated a significantly higher cumulative probability of not experiencing a new coronary event for the patients without silent ischemia (96.5%) as compared to those with silent ischemia (62.3%) (p < 0.01). Our results suggest that silent myocardial ischemia after a first uncomplicated myocardial infarction carries an adverse prognosis and should be routinely investigated.
authors.affiliation: Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina da Universidade de São Paulo, Brazil.
authors.forename: M C
authors.initials: MC
authors.lastname: Solimene
authors.forename: J A
authors.initials: JA
authors.lastname: Ramires
authors.forename: C J
authors.initials: CJ
authors.lastname: Gruppi
authors.forename: R G
authors.initials: RG
authors.lastname: Alfieri
authors.forename: S F
authors.initials: SF
authors.lastname: de Oliveira
authors.forename: P L
authors.initials: PL
authors.lastname: Da Luz
authors.forename: F
authors.initials: F
authors.lastname: Pileggi
mesh_terms: D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D006328:Cardiac Catheterization; D015897:Comorbidity; D017023:Coronary Angiography; D015716:Electrocardiography, Ambulatory; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D016019:Survival Analysis