The DOI matches its Crossref record.
Silent Ischemia as a Marker for Early Unfavorable Outcomes in Patients with Unstable Angina
Abstract
We examined the prevalence and prognostic importance of silent myocardial ischemia detected by continuous electrocardiographic monitoring in 70 patients with unstable angina. All the patients received intensive medical treatment with nitrates, beta-blockers, and calcium-channel blockers. Continuous electrocardiographic recordings were made during the first two days in the coronary care unit to quantify the frequency and duration of asymptomatic ischemic episodes, defined as a transient ST-segment shift of 1 mm or more. Thirty-seven patients (Group 1) had at least one episode of silent ischemia, and the other 33 patients had no silent ischemia (Group 2). Over the subsequent month, myocardial infarction occurred in 6 patients in Group 1 and in only 1 in Group 2 (P less than 0.01); bypass surgery or angioplasty was required for recurrent symptomatic angina in 10 patients in Group 1 and only 3 in Group 2 (P = 0.02). Survival-curve analysis demonstrated that silent ischemia was associated with these outcomes (P less than 0.002), and multivariate analysis showed that silent ischemia was the best predictor of these outcomes among the 15 variables tested (P less than 0.002). Patients in Group 1 with 60 minutes or more of silent ischemia per 24 hours had a worse prognosis than those with under 60 minutes per 24 hours (P = 0.04). Silent ischemia occurred in more than 50 percent of our patients with unstable angina, despite intensive medical therapy, and it identified a subset who were at high risk for early unfavorable outcomes.
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Citations
Cited by
Platelet Activation in Unstable Coronary Disease
Fitzgerald, D. J., Roy, L., Catella, F., & FitzGerald, G. A. (1986) · New England Journal of Medicine · doi:10.1056/nejm198610163151602 · Cited by 1,141
Drew, B. J., Califf, R. M., Funk, M., Kaufman, E. S., Krucoff, M. W., Laks, M. M., Macfarlane, P. W., Sommargren, C., Swiryn, S., & Van Hare, G. F. (2004) · Circulation · doi:10.1161/01.cir.0000145144.56673.59 · Cited by 609
ACC/AHA guidelines for ambulatory electrocardiography
Crawford, M. H., Bernstein, S. J., Deedwania, P. C., DiMarco, J. P., Ferrick, K. J., Garson, A., Green, L. A., Greene, H. L., Silka, M. J., Stone, P. H., et al. (1999) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(99)00354-x · Cited by 309
Rocco, M. B., Nabel, E. G., Campbell, S., Goldman, L., Barry, J., Mead, K., & Selwyn, A. P. (1988) · Circulation · doi:10.1161/01.cir.78.4.877 · Cited by 300
Kadish, A. H., Buxton, A. E., Kennedy, H. L., Knight, B. P., Mason, J. W., Schuger, C. D., Tracy, C. M., Winters, W. L., Boone, A. W., Elnicki, M., et al. (2001) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(01)01680-1 · Cited by 244
Silent ischemia predicts infarction and death during 2 year follow-up of unstable angina
Gottlieb, S. O., Weisfeldt, M. L., Ouyang, P., Mellits, E. D., & Gerstenblith, G. (1987) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(87)80267-x · Cited by 226
Self-citationUse of ambulatory electrocardiographic (Holter) monitoring
DiMarco, J. P., & Philbrick, J. T. (1990) · Annals of Internal Medicine · doi:10.7326/0003-4819-113-1-53 · Cited by 177
Pepine, C. J., Geller, N. L., Knatterud, G. L., Bourassa, M. G., Chaitman, B. R., Davies, R. F., Day, P., Deanfield, J. E., Goldberg, A. D., McMahon, R. P., et al. (1994) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(94)90534-7 · Cited by 105
Self-citationConti, C. R., Bavry, A. A., & Petersen, J. W. (2012) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2011.07.050 · Cited by 84
Gibson, C. M., Pride, Y. B., Buros, J. L., Ciaglo, L. N., Morrow, D. A., Scirica, B. M., & Stone, P. H. (2009) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2009.02.044 · Cited by 6
Metadata
- Authors
- Gottlieb, S. O., Weisfeldt, M. L., Ouyang, P., Mellits, E. D., & Gerstenblith, G.
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 1986-05-08
- Volume
- 314
- Issue
- 19
- Pages
- 1214-1219
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2314745108
- Cited by
- 675
- References
- 0
- FWCI
- 62.40
- Type
- journal article
- Language
- en
- Open access
- closed
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