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A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
18:11

A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis

Published on: December 28, 2012

Relationship between silent myocardial ischemia and coronary artery disease risk factors

Saurabh Malhotra1, Ravi Sharma, Dustin E Kliner

  • 1Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, A-429 Scaife Hall, 200 Lothrop Street, Pittsburgh, PA, 15213, USA, drsmalhotra@hotmail.com.

Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology
|May 31, 2013
PubMed

Insights

Silent myocardial ischemia (SMI) is uncommon in asymptomatic patients without known coronary artery disease (CAD). However, SMI prevalence increases with more CAD risk factors in patients under 74.

Area of Science:

  • Cardiology
  • Nuclear Cardiology
  • Diagnostic Imaging

Background:

  • The relationship between silent myocardial ischemia (SMI) and coronary artery disease (CAD) risk factors in asymptomatic individuals without prior CAD history is not well-defined.
  • Patients referred for stress myocardial perfusion imaging (MPI) without typical cardiac symptoms represent a unique population for this investigation.

Purpose of the Study:

  • To investigate the association between the number of coronary artery disease (CAD) risk factors and the prevalence and severity of silent myocardial ischemia (SMI).
  • To determine the prognostic significance of SMI in asymptomatic patients undergoing myocardial perfusion imaging (MPI).

Main Methods:

  • Retrospective analysis of 1,354 asymptomatic patients undergoing MPI (rest thallium-201/stress Tc-99m sestamibi).
  • Patients were categorized by the number of CAD risk factors (none, 1-2, 3-4, ≥5).
  • Silent myocardial ischemia (SMI) defined by summed differences score (SDS) ≥2; prognostically significant ischemia by SDS ≥8.

Main Results:

  • Silent myocardial ischemia (SMI) was present in 7.2% and prognostically significant ischemia in 4.4% of patients.
  • SMI prevalence, not severity, significantly increased with the number of CAD risk factors in patients <74 years (P=.001).
  • Only 2% of patients who underwent coronary angiography had significant anatomical CAD.

Conclusions:

  • Silent myocardial ischemia (SMI) and prognostically significant ischemia are infrequent in asymptomatic patients without known coronary artery disease (CAD).
  • The number of CAD risk factors is associated with SMI prevalence in patients younger than 74 years.
  • Myocardial perfusion imaging (MPI) can detect SMI in this population, guiding risk stratification.
Abstract

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