Risk factors for exercise-induced silent myocardial ischemia in healthy volunteers

Katzel, Leslie I.; Sorkin, John D.; Colman, Eric; Goldberg, Andrew P.; Busby-Whitehead, M. Janette; Lakatta, L.; Becker, Lewis C.; Lakatta, Edward G.; Fleg, Jerome L.

doi:10.1016/0002-9149(94)90578-9

Cited by 39 publications

(27 citation statements)

References 26 publications

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“…Silent ischemia has been shown to occur frequently in elderly patients. 28 In our study, preinfarction angina was slightly less frequent in elderly patients, but if we had taken silent ischemia into account, the benefits of preinfarction angina may have become clearer in elderly patients. Further prospective studies are needed to confirm whether the beneficial effects of preinfarction angina are preserved in elderly patients.…”

Section: Study Limitationsmentioning

confidence: 60%

Beneficial Effect of Preinfarction Angina on In-Hospital Outcome is Preserved in Elderly Patients Undergoing Coronary Intervention for Anterior Acute Myocardial Infarction

Kosuge

Kimura

Kojima

et al. 2005

Circ J

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rief episodes of ischemia before sustained coronary artery occlusion protect the heart by delaying lethal injury and significantly limiting the size of the infarct, an effect known as ischemic preconditioning. 1,2 Clinical studies have confirmed that angina shortly before the onset of acute myocardial infarction (AMI) is associated with a smaller infarct size and better short-and longterm outcomes. [3][4][5][6] However, it has been reported that in the thrombolytic era preinfarction angina limits infarct size and improves clinical outcome in nonelderly, not elderly, patients with AMI 7,8 and it remains unclear whether preinfarction angina has a beneficial effect on clinical outcome in elderly patients undergoing percutaneous coronary intervention (PCI). In this study, we assessed the relation of preinfarction angina to in-hospital outcome in nonelderly and elderly patients with anterior AMI who underwent PCI. Methods PatientsThe Japanese Acute Coronary Syndrome Study (JACSS) is a retrospective, observational multicenter trial 9 involving 484 patients with anterior AMI who fulfilled the following inclusion criteria: (1) admission within 24 h of symptom onset; (2) coronary angiography performed immediately after admission; (3) emergency percutaneous transluminal coronary angioplasty, stenting or both of the left anterior descending coronary artery (LAD); and (4) availability of a detailed clinical history. The diagnosis of anterior AMI was based on typical chest pain lasting more than 30 min, STsegment elevation of at least 1 mm in 2 contiguous precordial leads, and a subsequent increase in the serum creatine Background Preinfarction angina improves survival after acute myocardial infarction (AMI) in nonelderly but not elderly patients in the thrombolytic era. However, it remains unclear whether preinfarction angina has a beneficial effect on clinical outcome in elderly patients undergoing percutaneous coronary intervention (PCI). Methods and ResultsThe study group comprised 484 anterior AMI patients who were admitted within 24 h of onset and underwent emergency PCI. Patients were divided into 2 groups: those aged <70 years (nonelderly patients, n=290) and those aged ≥70 years (elderly patients, n=194). Angina within 24 h before AMI was present in 42% of nonelderly patients and in 37% of elderly patients. In nonelderly patients, preinfarction angina was associated with a lower in-hospital mortality rate (1% vs 7%, p=0.02). Similarly, in elderly patients, preinfarction angina was associated with a lower in-hospital mortality rate (6% vs 16%, p=0.03). Multivariate analysis showed that the absence of preinfarction angina was an independent predictor of in-hospital mortality in both nonelderly (odds ratio 4.20; 95% confidence interval (CI) 1.20-10.6; p=0.04) and elderly patients (odds ratio 3.04; 95%CI 1.06-18.1; p=0.04). Conclusions Angina within the 24 h before AMI is associated with better in-hospital outcomes in elderly and nonelderly patients. (Circ J 2005; 69: 630 -635)

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Section: Study Limitationsmentioning

confidence: 60%

Beneficial Effect of Preinfarction Angina on In-Hospital Outcome is Preserved in Elderly Patients Undergoing Coronary Intervention for Anterior Acute Myocardial Infarction

Kosuge

Kimura

Kojima

et al. 2005

Circ J

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“…6) The incidence of silent myocardial ischemia is estimated at 0.5% to 15%. 10,12,14,18,19,26) Patients with silent myocardial ischemia have three-to five-fold higher risk of symptomatic coronary artery disease and cardiac death compared with nonischemic control subjects. 15,19,31) Silent myocardial ischemia can be identified by 24-hour continuous ambulatory ECG monitoring, thallium perfusion scintigraphy, and dobutamine echocardiography.…”

Section: Discussionmentioning

confidence: 99%

“…10,12,14,18,19,26) Patients with silent myocardial ischemia have three-to five-fold higher risk of symptomatic coronary artery disease and cardiac death compared with nonischemic control subjects. 15,19,31) Silent myocardial ischemia can be identified by 24-hour continuous ambulatory ECG monitoring, thallium perfusion scintigraphy, and dobutamine echocardiography. 10,13,19,22,27) Elderly patients requiring lumbar fusion surgery usually have neurogenic claudication caused by spinal stenosis and thus cannot walk the long distances required to stress the cardiovascular system.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Perioperative Cardiac Complications After Lumbar Fusion Surgery

Lee

Jang

2007

Neurol. Med. Chir.(Tokyo)

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Cardiac complication is a leading cause of death in the perioperative period after non-cardiac surgery. The present study retrospectively investigated perioperative cardiac complications after spinal fusion surgery in 901 consecutive adult patients who underwent fusion surgery in the lumbar spine from January 2005 to December 2006. Cardiac complications developed in seven patients (0.8%), four males and three females aged 62 to 75 years (mean 66.6 years), in the perioperative period (myocardial infarction in 6 and angina pectoris in 1). Cardiac complications developed after mini-open transforaminal lumbar interbody fusion in four patients and after anterior lumbar interbody fusion in three. No patient had any symptoms related to cardiac disease before surgery. Common features were age over 60 years, a medical history of hypertension and/or diabetes mellitus, and presence of calcified atherosclerosis of the abdominal aorta and/or common iliac arteries. Five patients improved after conservative medical treatment in an intensive care unit. Percutaneous transluminal coronary angioplasty was performed in one patient and coronary artery bypass graft surgery in one. The possibility of perioperative cardiac complications should be considered before lumbar fusion surgery, especially in elderly patients with hypertension and/or diabetes mellitus, and calcified atherosclerosis of the abdominal aorta and/or common iliac arteries.

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“…Studies have shown that sudden death, and death with other consequences of coronary artery disease are more frequent in patients with silent ischaemia. 27,28 However, to date no study has investigated silent ischaemia in subjects with WCH. Ours is the first study on this subject as far as we are aware.…”

Section: Discussionmentioning

confidence: 99%

The prevalence of silent myocardial ischaemia in patients with white-coat hypertension

et al. 1998

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The aim of this study was to estimate the incidence of silent myocardial ischaemia in patients with mild to moderate hypertension, white-coat hypertension (WCH) and those with normal blood pressure. Ambulatory electrocardiographic (ECG) monitoring was carried out in 272 cases with normal blood pressure, 164 cases with mild to moderate hypertension (diastolic blood pressure Ͼ95 and Ͻ114 mm Hg), and 106 cases with white-coat hypertension who were diagnosed with ambulatory blood pressure monitoring. The ages of the patients of all groups were between 42-61 years. There were no differences between the groups according to age, gender

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Risk factors for exercise-induced silent myocardial ischemia in healthy volunteers

Cited by 39 publications

References 26 publications

Beneficial Effect of Preinfarction Angina on In-Hospital Outcome is Preserved in Elderly Patients Undergoing Coronary Intervention for Anterior Acute Myocardial Infarction

Beneficial Effect of Preinfarction Angina on In-Hospital Outcome is Preserved in Elderly Patients Undergoing Coronary Intervention for Anterior Acute Myocardial Infarction

Risk Factors for Perioperative Cardiac Complications After Lumbar Fusion Surgery

The prevalence of silent myocardial ischaemia in patients with white-coat hypertension

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