Silent ischemia predicts infarction and death during 2 year follow-up of unstable angina
Open accessAbstract
Silent myocardial ischemia as detected on Holter electrocardiographic (ECG) monitoring is present in greater than 50% of patients with unstable angina despite intensive medical therapy. The presence and the extent of silent ischemia have been correlated with an increased risk of early (1 month) unfavorable outcome including myocardial infarction and need for coronary revascularization for persistent symptoms. Seventy patients with unstable angina who had undergone continuous ECG monitoring for silent ischemia were followed up for 2 years; 37 patients (Group I) had Holter ECG evidence of silent ischemia at bed rest in the coronary care unit during medical treatment with nitrates, beta-receptor blockers and calcium channel antagonists; the other 33 patients (Group II) had no ischemic ST segment changes (symptomatic or silent) on Holter monitoring. Over a 2 year follow-up period, myocardial infarction occurred in 10 patients in Group I (in 2 it was fatal) compared with one nonfatal infarction in Group II (p less than 0.01 by Kaplan-Meier analysis); revascularization with either coronary bypass surgery or angioplasty for symptomatic ischemia was performed in 11 Group I and 5 Group II patients (p less than 0.05). Multivariate Cox's hazard analysis demonstrated that the presence of silent ischemia was the best predictor of 2 year outcome. Therefore, persistent silent myocardial ischemia despite medical therapy in patients with unstable angina carries adverse prognostic implications that persist over a 2 year period.
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In patients with unstable coronary syndromes, silent ischemia can predict both short-term and long-term risk.
“In patients with unstable coronary syndromes, silent ischemia can predict both short-term and long-term risk (Gibson et al., 2009;Gottlieb, Weisfeldt, Ouyang, Mellits, & Gerstenblith, 1987;Langer, Singh, Freeman, Tibshirani, & Armstrong, 1995;Patel et al., 1997;Scirica et al., 2009).”
From 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry (2017) · cites this paper as Gottlieb et al., 1987
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References 33 · Cited by 226
- Authors
- Gottlieb, S. O., Weisfeldt, M. L., Ouyang, P., Mellits, E. D., & Gerstenblith, G.
- Affiliations
- Johns Hopkins Bayview Medical Center (US)
- Corresponding author
- Gottlieb, Sidney O.
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 1987-10
- Volume
- 10
- Issue
- 4
- Pages
- 756-760
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2064240730
- Cited by
- 226
- References
- 33
- Citations by year
- 2021: 1 · 2019: 1 · 2017: 3 · 2016: 2 · 2015: 3 · 2014: 1 · 2013: 1 · 2012: 3
- FWCI
- 18.57
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Heart, Lung, and Blood Institute (HL17655-12)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart rate and cardiovascular health
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Keywords
- silent myocardial ischemia, unstable angina, Holter monitoring, myocardial infarction, mortality, coronary revascularization, prognosis, ST-segment changes, medical therapy, beta-blockers, calcium channel blockers, nitrate
- MeSH terms
- Angina Pectoris, Angina, Unstable, Coronary Disease, Electrocardiography, Follow-Up Studies, Humans, Monitoring, Physiologic, Myocardial Infarction, Prognosis, Risk
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