Long-term follow-up of patients with silent ischemia during exercise radionuclide angiography

Abstract

A retrospective 5 year follow-up study was performed in 140 patients with unequivocal ischemia during exercise radionuclide angiography (greater than or equal to 10% decrease in left ventricular ejection fraction or greater than or equal to 5% decrease in ejection fraction together with a distinct regional wall motion abnormality). In 84 patients (60%), ischemia during radionuclide angiography was silent (silent ischemia group), whereas 56 patients experienced angina during the test (symptomatic group). Work load and antianginal medication were similar in both groups. Critical cardiac events (unstable angina, myocardial infarction, cardiac death) occurred in 27% of patients in the silent ischemia group and 16% of those in the symptomatic group (p = NS); however, myocardial infarction or death was more frequent in patients with silent ischemia (22% versus 9%; p less than 0.05). If there was additional exercise-induced ST segment depression, the rate of critical events was further increased (p less than 0.05). The difference in critical cardiac events seemed to be influenced by the higher incidence of revascularization procedures in symptomatic patients, whereas medical therapy had no similar effect. Thus, these findings suggest that patients with documented severe ischemia should undergo left heart catheterization and revascularization irrespective of symptoms to improve their prognosis.

Effects of Percutaneous Coronary Interventions in Silent Ischemia After Myocardial Infarction

“…[3][4][5][6] Despite these consistent findings, there are few prospective data unequivocally documenting a benefit of anti-ischemic therapy on prognosis in patients with silent ischemia. 7 There is some indirect evidence of a better outcome after repeat PCI for silent restenosis.…”

“…ILENT ISCHEMIA HAS BEEN SHOWN to predict adverse prognosis in patients after myocardial infarction (MI), 1 coronary artery bypass graft surgery, 2 and percutaneous coronary intervention (PCI) with or without stenting. [3][4][5][6] Despite these consistent findings, there are few prospective data unequivocally documenting a benefit of anti-ischemic therapy on prognosis in patients with silent ischemia. 7 There is some indirect evidence of a better outcome after repeat PCI for silent restenosis.…”

Exercise stress testing before and after successful multivessel percutaneous transluminal coronary angioplasty

“…Despite technological advances and a better understanding of its pathophysiology, restenosis remains the major limitation of PCI, normally occurring within the first 6 months after angioplasty. A major clinical problem is the noninvasive detection of restenosis among asymptomatic patients, because silent ischemia has been reported to be a predictor of mortality and cardiac events in patients with coronary artery disease (2)(3)(4)(5). Coronary angiography (CA) has been traditionally used as the gold standard for detecting restenosis.…”

Valor prognóstico de provas funcionais na evolução tardia de pacientes com infarto agudo do miocárdio tratados com angioplastia coronária transluminal percutânea primária com implante de stent

“…A busca de valores mais expressivos de sensibilidade e especifidade das provas funcionais após intervenções percutâneas e o reconhecimento da importância da isquemia silenciosa como fator determinante de mau prognóstico (Davies et al, 1997, Stone et al, 1997, Breitenbucher et al, 1990) levou à indicação de métodos diagnósticos associados a imagem cardíaca, dentre os quais destaca-se a cintilografia de perfusão miocárdica. (Beller et al, 2000).…”