TY - JOUR
T1 - Detection and Significance of Myocardial Ischemia in Stable Patients After Recovery From an Acute Coronary Event
AU - The Multicenter Myocardial Ischemia Research Group
AU - Moss, Arthur J.
AU - Goldstein, Robert E.
AU - Hall, W. Jackson
AU - Bigger, J. Thomas
AU - Fleiss, Joseph L.
AU - Greenberg, Henry
AU - Bodenheimer, Monty
AU - Krone, Ronald J.
AU - Marcus, Frank I.
AU - Wackers, Frans J.Th
AU - Benhorin, Jesaia
AU - Brown, Mary W.
AU - Case, Robert
AU - Coromilas, James
AU - Dwyer, Edward M.
AU - Gillespie, John A.
AU - Gregory, John J.
AU - Kleiger, Robert
AU - Lichstein, Edgar
AU - Parker, John O.
AU - Raubertas, Richard F.
AU - Stern, Shlomo
AU - Tzivoni, Dan
AU - Van Voorhees, Lucy
PY - 1993/5/12
Y1 - 1993/5/12
N2 - Objective.—To determine the clinical significance of silent and symptomatic myocardial ischemia detected by noninvasive testing in stable postcoronary patients. Design.—Cohort study with a mean 23-month follow-up. Setting.—Ambulatory outpatients after recent hospitalization for an acute coronary event. Patients.—Nine hundred thirty-six patients (76% male; mean age, 58 years) who were clinically stable 1 to 6 months after hospitalization for acute myocardial infarction or unstable angina. Interventions.—Noninvasive testing involved rest, ambulatory, and exercise electrocardiograms and stress thallium-201 scintigraphy. Main Outcome Measures.—Cox regression analysis was used to evaluate the risk (hazard ratio) of first recurrent primary events (cardiac death, nonfatal infarction, or unstable angina) or restricted events (cardiac death or nonfatal infarction) associated with ischemic noninvasive test results. Results.—ST segment depression on the rest electrocardiogram was the only noninvasive test variable that identified a significantly increased risk (P=.05) for first recurrent primary events (hazard ratio; 95% confidence limits): rest electrocardiogram ST depression (1.5; 1.00,2.25); ambulatory electrocardiogram ST depression (0.86; 0.49,1.51); exercise electrocardiogram ST depression (1.13; 0.82,1.56); and stress thallium-201 reversible defects (1.3; 0.96,1.74). Test results were similar for first recurrent restricted events, and in patients with and without angina. Significantly increased risk (P<.05) was noted when exercise-induced ST depression occurred in patients who also had reduced exercise duration (hazard ratio, 3.4) or when reversible thallium-201 defects occurred in patients who also had increased lung uptake (hazard ratio, 2.8). Each high-risk subset made up less than 3% of the population and contained less than 6% of patients with first primary events. Conclusion.—Detection of silent or symptomatic myocardial ischemia by noninvasive testing in stable patients 1 to 6 months after an acute coronary event is not useful in identifying patients at increased risk for subsequent coronary events.
AB - Objective.—To determine the clinical significance of silent and symptomatic myocardial ischemia detected by noninvasive testing in stable postcoronary patients. Design.—Cohort study with a mean 23-month follow-up. Setting.—Ambulatory outpatients after recent hospitalization for an acute coronary event. Patients.—Nine hundred thirty-six patients (76% male; mean age, 58 years) who were clinically stable 1 to 6 months after hospitalization for acute myocardial infarction or unstable angina. Interventions.—Noninvasive testing involved rest, ambulatory, and exercise electrocardiograms and stress thallium-201 scintigraphy. Main Outcome Measures.—Cox regression analysis was used to evaluate the risk (hazard ratio) of first recurrent primary events (cardiac death, nonfatal infarction, or unstable angina) or restricted events (cardiac death or nonfatal infarction) associated with ischemic noninvasive test results. Results.—ST segment depression on the rest electrocardiogram was the only noninvasive test variable that identified a significantly increased risk (P=.05) for first recurrent primary events (hazard ratio; 95% confidence limits): rest electrocardiogram ST depression (1.5; 1.00,2.25); ambulatory electrocardiogram ST depression (0.86; 0.49,1.51); exercise electrocardiogram ST depression (1.13; 0.82,1.56); and stress thallium-201 reversible defects (1.3; 0.96,1.74). Test results were similar for first recurrent restricted events, and in patients with and without angina. Significantly increased risk (P<.05) was noted when exercise-induced ST depression occurred in patients who also had reduced exercise duration (hazard ratio, 3.4) or when reversible thallium-201 defects occurred in patients who also had increased lung uptake (hazard ratio, 2.8). Each high-risk subset made up less than 3% of the population and contained less than 6% of patients with first primary events. Conclusion.—Detection of silent or symptomatic myocardial ischemia by noninvasive testing in stable patients 1 to 6 months after an acute coronary event is not useful in identifying patients at increased risk for subsequent coronary events.
UR - http://www.scopus.com/inward/record.url?scp=0027223292&partnerID=8YFLogxK
U2 - 10.1001/jama.1993.03500180071037
DO - 10.1001/jama.1993.03500180071037
M3 - Article
C2 - 8479063
AN - SCOPUS:0027223292
SN - 0098-7484
VL - 269
SP - 2379
EP - 2385
JO - JAMA - Journal of the American Medical Association
JF - JAMA - Journal of the American Medical Association
IS - 18
ER -