Prognostic significance of transient ST segment changes after coronary artery bypass surgery: a long-term (4-10 year) follow up study.

Patel, Deven; Mulcahy, David; Curzen, Nicholas; Sullivan, A K; Cunningham, David A.; Sparrow, Jane; Wright, Christine; Quyyumi, Arshed A.; Fox, Kim

doi:10.1136/hrt.70.4.337

Cited by 10 publications

(3 citation statements)

References 23 publications

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“…[67][68][69][70][71] Also, although one small study found the presence of ambulatory ischemia after coronary artery bypass graft surgery to be associated with a significant excess of adverse clinical events, 72 this finding was disproved by further larger studies. 73,74 The problem of small size, which plagued earlier investigations, was resolved with the publication during the 1990s of a number of studies [75][76][77][78][79][80] of sufficient magnitude and statistical power (300 to 1000 patients followed up over 1 to 3 years) to answer with confidence the question of the importance of silent ischemia on ambulatory monitoring. The largest of these studies was the Multicenter Study of Myocardial Ischemia (MSMI) study 75 (nϭ943), which demonstrated no significant increase in primary cardiac events associated with ambulatory ischemia in stable patients Ͼ1 month (1 to 6 months) after MI or unstable angina.…”

Section: Patients With Anginamentioning

confidence: 99%

Silent Myocardial Ischemia

2003

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Section: Patients With Anginamentioning

confidence: 99%

Silent Myocardial Ischemia

2003

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“…It should be mentioned that mortality of UA is highest at the time of hospital admission and decreases over the next two months. Patel et al (46) studied 212 patients with UA, average age 59 years, recruited within 24 h of an anginal episode. Death, myocardial infarction and/or revascularisation were assessed for 2.6 years.…”

Section: Definition Of High and Low Risk Patientsmentioning

confidence: 99%

Unstable Angina in 1998

Lichtlen¹

1999

Thromb Haemost

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SummaryUnstable angina (UA) and non-Q-wave myocardial infarction (NQWMI) are acute coronary syndromes with repeated, severe ischemic events of short duration. These events are mainly due to a rapid decrease in coronary blood flow, and to a rapid, reversible reduction of the arterial lumen in localized areas. Episodes often are a mixture of thrombus formation due to platelet aggregation and localized spasm, leading to vasoconstriction. Due to the short interval (minutes) of ischemic events, usually no or minimal irreversible myocardial damage takes place.The main goal of treatment is to prevent progression of this unstable situtation into a myocardial infarction. In the majority of cases, this is possible with adequate treatment of vasodilatory substances like nitrates, long-acting dihydropyridines like amlodipine and betablockers. In addition heparin and particular antiaggregatory drugs inhibiting platelet activation by blocking the GPIIb/IIIa receptor, the common pathway for platelet aggregation, are applied to prevent thrombus formation. This, in the majority of cases allows a passivation of the acute situtation, leaving time to undertake possible further steps as coronary angiography, eventually followed by PTCA of the culprit lesion or, in advanced cases of CAD, by CABG with complete revascularization.

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“…Thus, ischemia detected on ambulatory ECG monitoring may predict adverse outcomes during short-term follow-up but not necessarily during long-term follow-up. [7][8][9] Furthermore, since the activity of coronary artery disease may fluctuate over time, ambulatory ischemia may be absent soon after infarction, as the lesion involved heals, but may develop later in some patients, if new unstable lesions develop. Consequently, the absence of ischemia early after infarction may not be highly predictive of the long-term outcome.…”

Section: Prognostic Implications Of Silent Myocardial Ischemiamentioning

confidence: 99%