Circulation, Vol 81, 748-756, Copyright © 1990 by American Heart Association
PC Deedwania and EV Carbajal
We prospectively examined the prognostic significance of silent myocardial
ischemia detected by ambulatory electrocardiogram (ECG) monitoring during
daily life in 107 patients with long-term stable angina who were
symptomatically controlled on conventional antianginal agents. Forty-six
patients (group 1) demonstrated one or more episodes (87% silent) of
myocardial ischemia; the remaining 61 patients (group 2) had no ischemic ST
segment changes. During the mean follow-up period of 23 +/- 8 months, 11
cardiac deaths (five sudden and six nonsudden) occurred in group 1, and
five cardiac deaths (all nonsudden) occurred in group 2. Kaplan-Meier
survival analysis between the groups confirmed that patients with silent
ischemia (group 1) had worse prognoses during the follow-up period (p =
0.023). Although the higher incidence of hypertension, smoking,
hypercholesterolemia, and diabetes in our patients might reflect a more
sickly population of stable angina patients, the multivariate Cox's hazard
function analysis of these and other variables including Q waves on ECG,
exercise parameters, and ambulatory ECG findings revealed presence of
silent ischemia during daily life as the most powerful and independent
predictor of cardiac mortality (p = 0.01). These data indicate that, in
such patients with stable angina, silent myocardial ischemia occurs
frequently during treatment with conventional antianginal drugs and
identifies a subset of patients who are at high risk of cardiac death.
ARTICLES
Silent ischemia during daily life is an independent predictor of mortality in stable angina
Department of Medicine, UCSF Program/VAMC 93703.
This article has been cited by other articles:
 |
|
 |
|
  M. Dweck, I. W Campbell, D. Miller, and C M. Francis Clinical aspects of silent myocardial ischaemia: with particular reference to diabetes mellitus The British Journal of Diabetes & Vascular Disease, May 1, 2009; 9(3): 110 - 116. [Abstract] [PDF]
|
|
|
|
 |
|
 P. Deedwania, P. H. Stone, C. N. Bairey Merz, J. Cosin-Aguilar, N. Koylan, D. Luo, P. Ouyang, R. Piotrowicz, K. Schenck-Gustafsson, P. Sellier, et al. Effects of Intensive Versus Moderate Lipid-Lowering Therapy on Myocardial Ischemia in Older Patients With Coronary Heart Disease: Results of the Study Assessing Goals in the Elderly (SAGE) Circulation, February 13, 2007; 115(6): 700 - 707. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Enseleit and F. Duru Long-term continuous external electrocardiographic recording: a review. Europace, April 1, 2006; 8(4): 255 - 266. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Sajadieh, O. W. Nielsen, V. Rasmussen, H. O. Hein, and J. F. Hansen Prevalence and prognostic significance of daily-life silent myocardial ischaemia in middle-aged and elderly subjects with no apparent heart disease Eur. Heart J., July 2, 2005; 26(14): 1402 - 1409. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. H. Stone, D. M. Lloyd-Jones, S. Kinlay, B. Frei, W. Carlson, J. Rubenstein, T. C. Andrews, M. Johnstone, G. Sopko, H. Cole, et al. Effect of Intensive Lipid Lowering, With or Without Antioxidant Vitamins, Compared With Moderate Lipid Lowering on Myocardial Ischemia in Patients With Stable Coronary Artery Disease: The Vascular Basis for the Treatment of Myocardial Ischemia Study Circulation, April 12, 2005; 111(14): 1747 - 1755. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I Ikonomidis, F Andreotti, and P Nihoyannopoulos Reduction of daily life ischaemia by aspirin in patients with angina: underlying link between thromboxane A2 and macrophage colony stimulating factor Heart, April 1, 2004; 90(4): 389 - 393. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Bibbins-Domingo, M. Ansari, N. B. Schiller, B. Massie, and M. A. Whooley B-Type Natriuretic Peptide and Ischemia in Patients With Stable Coronary Disease: Data From the Heart and Soul Study Circulation, December 16, 2003; 108(24): 2987 - 2992. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. F. Cohn, K. M. Fox, and C. Daly Silent Myocardial Ischemia Circulation, September 9, 2003; 108(10): 1263 - 1277. [Full Text] [PDF]
|
|
|
|
|
|
R. J. Adams, M. I. Chimowitz, J. S. Alpert, I. A. Awad, M. D. Cerqueria, P. Fayad, and K. A. Taubert Coronary Risk Evaluation in Patients With Transient Ischemic Attack and Ischemic Stroke: A Scientific Statement for Healthcare Professionals From the Stroke Council and the Council on Clinical Cardiology of the American Heart Association/American Stroke Association Circulation, September 9, 2003; 108(10): 1278 - 1290. [Full Text] [PDF]
|
|
|
|
 |
|
 R. J. Adams, M. I. Chimowitz, J. S. Alpert, I. A. Awad, M. D. Cerqueria, P. Fayad, and K. A. Taubert Coronary Risk Evaluation in Patients With Transient Ischemic Attack and Ischemic Stroke: A Scientific Statement for Healthcare Professionals From the Stroke Council and the Council on Clinical Cardiology of the American Heart Association/American Stroke Association Stroke, September 1, 2003; 34(9): 2310 - 2322. [Full Text] [PDF]
|
|
|
|
 |
|
 C. Desouza, H. Salazar, B. Cheong, J. Murgo, and V. Fonseca Association of Hypoglycemia and Cardiac Ischemia: A study based on continuous monitoring Diabetes Care, May 1, 2003; 26(5): 1485 - 1489. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Cice, A. Di Benedetto, A. D'Andrea, S. D'Isa, L. Ferrara, P. E. Russo, A. Iacono, and R. Calabro Sustained-Release Diltiazem Reduces Myocardial Ischemic Episodes in End-Stage Renal Disease: A Double-Blind, Randomized, Crossover, Placebo-Controlled Trial J. Am. Soc. Nephrol., April 1, 2003; 14(4): 1006 - 1011. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. K. Nair, I. A. Khan, D. J. Esterbrooks, K. L. Ryschon, and D. E. Hilleman Diagnostic and Prognostic Value of Holter-Detected ST-Segment Deviation in Unselected Patients With Chest Pain Referred for Coronary Angiography : A Long-term Follow-up Analysis Chest, September 1, 2001; 120(3): 834 - 839. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Landesberg, M. Mosseri, D. Zahger, Y. Wolf, M. Perouansky, H. Anner, B. Drenger, Y. Hasin, Y. Berlatzky, and C. Weissman Myocardial infarction after vascular surgery: the role of prolonged, stress-induced, ST depression-type ischemia J. Am. Coll. Cardiol., June 1, 2001; 37(7): 1839 - 1845. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. De Lorenzo, Z. Kadziola, V.V. Kakkar, and H. Xiao Silent myocardial ischaemia after coronary artery bypass graft QJM, October 1, 2000; 93(10): 701 - 702. [Full Text]
|
|
|
|
|
|
M. H. Crawford, S. J. Bernstein, P. C. Deedwania, J. P. DiMarco, K. J. Ferrick, A. Garson Jr, L. A. Green, H. L. Greene, M. J. Silka, P. H. Stone, et al. ACC/AHA guidelines for ambulatory electrocardiography: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the Guidelines for Ambulatory Electrocardiography) developed in collaboration with the North American Society for Pacing and Electrophysiology J. Am. Coll. Cardiol., September 1, 1999; 34(3): 912 - 948. [Full Text] [PDF]
|
|
|
|
|
|
F. Weber, H. Schneider, T. von Arnim, and W. Urbaszek Heart rate variability and ischaemia in patients with coronary heart disease and stable angina pectoris: Influence of drug therapy and prognostic value Eur. Heart J., January 1, 1999; 20(1): 38 - 50. [Abstract] [PDF]
|
|
|
|
|
|
R. G. Favaloro Landmarks in the Development of Coronary Artery Bypass Surgery Circulation, August 4, 1998; 98(5): 466 - 478. [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Blumenthal, W. Jiang, M. A. Babyak, D. S. Krantz, D. J. Frid, R. E. Coleman, R. Waugh, M. Hanson, M. Appelbaum, C. O'Connor, et al. Stress Management and Exercise Training in Cardiac Patients With Myocardial Ischemia: Effects on Prognosis and Evaluation of Mechanisms Arch Intern Med, October 27, 1997; 157(19): 2213 - 2223. [Abstract] [PDF]
|
|
|
|
|
|
D. Tzivoni, H. Kadr, S. Braat, W. Rutsch, J. A. Ramires, and I. Kobrin Efficacy of Mibefradil Compared With Amlodipine in Suppressing Exercise-Induced and Daily Silent Ischemia : Results of a Multicenter, Placebo-Controlled Trial Circulation, October 21, 1997; 96(8): 2557 - 2564. [Abstract] [Full Text]
|
|
|
|
 |
|
 P. C. Deedwania and E. V. Carbajal Can Ambulatory Monitoring Identify High-Risk Patients With Stable Coronary Artery Disease? JAMA, June 11, 1997; 277(22): 1760 - 1760. [Abstract] [PDF]
|
|
|
|
|
|
A. A. Quyyumi and D. Mulcahy Can Ambulatory Monitoring Identify High-Risk Patients With Stable Coronary Artery Disease?-Reply JAMA, June 11, 1997; 277(22): 1760 - 1761. [Abstract] [PDF]
|
|
|
|
|
|
T. Killip Silent Myocardial Ischemia: Some Good News Circulation, April 15, 1997; 95(8): 1992 - 1993. [Full Text]
|
|
|
|
|
|
R. F. Davies, A. D. Goldberg, S. Forman, C. J. Pepine, G. L. Knatterud, N. Geller, G. Sopko, C. Pratt, J. Deanfield, and C. R. Conti Asymptomatic Cardiac Ischemia Pilot (ACIP) Study Two-Year Follow-up : Outcomes of Patients Randomized to Initial Strategies of Medical Therapy Versus Revascularization Circulation, April 15, 1997; 95(8): 2037 - 2043. [Abstract] [Full Text]
|
|
|
|
|
|
D. Mulcahy, S. Husain, G. Zalos, A. Rehman, N. P. Andrews, W. H. Schenke, N. L. Geller, and A. A. Quyyumi Ischemia During Ambulatory Monitoring as a Prognostic Indicator in Patients With Stable Coronary Artery Disease JAMA, January 22, 1997; 277(4): 318 - 324. [Abstract] [PDF]
|
|
|
|
 |
|
 W. H. Frishman Mibefradil: A New Selective T-Channel Calcium Antagonist for Hypertension and Angina Pectoris Journal of Cardiovascular Pharmacology and Therapeutics, January 1, 1997; 2(4): 321 - 330. [Abstract] [PDF]
|
|
|
|
 |
|
 M. P. Corder, J. L. Monaco, T. Kraf, and R. I. Levin The Introduction of Ambulatory Electrocardiographic Monitoring for the Diagnosis and Management of Myocardial Ischemia American Journal of Medical Quality, January 1, 1997; 12(3): 169 - 174. [Abstract] [PDF]
|
|
|
|
|
|
P. H. Stone, B. R. Chaitman, R. P. McMahon, T. C. Andrews, G. MacCallum, B. Sharaf, W. Frishman, J. E. Deanfield, G. Sopko, C. Pratt, et al. Asymptomatic Cardiac Ischemia Pilot (ACIP) Study: Relationship Between Exercise-Induced and Ambulatory Ischemia in Patients With Stable Coronary Disease Circulation, October 1, 1996; 94(7): 1537 - 1544. [Abstract] [Full Text]
|
|
|
|
 |
|
 S. Ghione Hypertension-Associated Hypalgesia: Evidence in Experimental Animals and Humans, Pathophysiological Mechanisms, and Potential Clinical Consequences Hypertension, September 1, 1996; 28(3): 494 - 504. [Abstract] [Full Text]
|
|
|
|
|
|
M. Chiariello and C. Indolfi Silent Myocardial Ischemia in Patients With Diabetes Mellitus Circulation, June 15, 1996; 93(12): 2089 - 2091. [Full Text]
|
|
|
|
|
|
W. Jiang, M. Babyak, D. S. Krantz, R. A. Waugh, R. E. Coleman, M. M. Hanson, D. J. Frid, S. McNulty, J. J. Morris, C. M. O'Connor, et al. Mental Stress--Induced Myocardial Ischemia and Cardiac Events JAMA, June 5, 1996; 275(21): 1651 - 1656. [Abstract] [PDF]
|
|
|
|
|
|
M. G. Bourassa, G. L. Knatterud, C. J. Pepine, G. Sopko, W. J. Rogers, N. L. Geller, I. Dyrda, S. A. Forman, B. R. Chaitman, B. Sharaf, et al. Asymptomatic Cardiac Ischemia Pilot (ACIP) Study : Improvement of Cardiac Ischemia at 1 Year After PTCA and CABG Circulation, November 1, 1995; 92(9): 1 - 7. [Abstract] [Full Text]
|
|
|
|
|
|
A. J. Moss, R. E. Goldstein, W. J. Hall, J. T. Bigger Jr, J. L. Fleiss, H. Greenberg, M. Bodenheimer, R. J. Krone, F. I. Marcus, F. J. Th. Wackers, et al. Detection and Significance of Myocardial Ischemia in Stable Patients After Recovery From an Acute Coronary Event JAMA, May 12, 1993; 269(18): 2379 - 2385. [Abstract] [PDF]
|
|
|
|
|
|
P. C. Deedwania and E. V. Carbajal Silent Myocardial Ischemia: A Clinical Perspective Arch Intern Med, December 1, 1991; 151(12): 2373 - 2382. [Abstract] [PDF]
|
|
|
|
 |
|
 SHOULD SILENT ISCHEMIA BE TREATED Journal Watch (General), March 30, 1990; 1990(330): 5 - 5. [Full Text]
|
|