title: Prognosis of "clandestine" myocardial ischemia, silent myocardial ischemia, and angina pectoris in medically treated patients.
abstract: The aim of this study was to assess the prognosis of medically treated patients with "clandestine" myocardial ischemia (perfusion defect without angina and no ST depression > 1 mm during exercise test) compared to those with silent myocardial ischemia (ST-segment depression > 1 mm, without angina) and those with angina pectoris. One hundred twelve patients without previous myocardial infarction were included. All patients underwent a symptom-limited exercise test on a bicycle ergometer, myocardial perfusion technetium-99m-methoxy-isobutyl-isonitrile single-photon emission computed tomography (SPECT), and coronary angiography. They were classified into 3 groups (angina group, 34 patients; silent group, 20 patients; and the clandestine group, 58 patients). The mean follow-up was 3.6 years (range 6 months to 5.5 years). Patients with clandestine ischemia had a lower scintigraphic and angiographic score than patients with silent ischemia (25+/-8 vs 31+/-9 and 24+/-8 vs 29+/-7, p = 0.008, respectively), but the prognosis was similar. Only angina and severe reversible SPECT defects were predictive for cardiac events: death + myocardial infarction + revascularization. We conclude that in medically treated patients without previous myocardial infarction, angina and severe reversible SPECT defects are predictive for cardiac events only when the need for revascularization is included as a cardiac event.
authors.affiliation: Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain. jcandell@hg.vhebron.es
authors.forename: J
authors.initials: J
authors.lastname: Candell-Riera
authors.forename: C
authors.initials: C
authors.lastname: Santana-Boado
authors.forename: B
authors.initials: B
authors.lastname: Bermejo
authors.forename: J
authors.initials: J
authors.lastname: Castell-Conesa
authors.forename: S
authors.initials: S
authors.lastname: Aguadé-Bruix
authors.forename: T
authors.initials: T
authors.lastname: Canela
authors.forename: J
authors.initials: J
authors.lastname: Soler-Soler
mesh_terms: D000787:Angina Pectoris / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D017023:Coronary Angiography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000145:classification / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D011379:Prognosis; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi