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[Silent ischemia in patients with previous myocardial infarct. Correlation of Holter and coronarography]
Insights
Silent myocardial ischemia was detected in 22.6% of patients with prior myocardial infarction. This condition often correlated with severe, multi-vessel coronary obstructions, suggesting a need for further investigation.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Ischemic Heart Disease
Background:
- Silent myocardial ischemia, a critical condition, often goes undiagnosed in patients with a history of myocardial infarction.
- Understanding the correlation between silent ischemia and coronary artery disease severity is crucial for patient management.
Purpose of the Study:
- To ascertain the prevalence of silent myocardial ischemia in patients with previous myocardial infarction.
- To evaluate the degree of coronary obstructions associated with silent ischemia.
- To identify potential indicators for surgical intervention in affected patients.
Main Methods:
- A cohort of 62 patients with a history of myocardial infarction was studied.
- All participants underwent Holter monitoring for ischemia detection.
- Coronary angiography was performed to assess the extent and severity of coronary artery disease.
Main Results:
- Silent myocardial ischemia was identified in 14 (22.6%) of the patients.
- Patients with silent ischemia frequently exhibited severe coronary obstructions, particularly 3-vessel disease (50%) and >90% occlusive lesions (86%).
- Lesions were predominantly located in the proximal segment of the coronary arteries (79%).
Conclusions:
- Silent myocardial ischemia in post-myocardial infarction patients is strongly linked to multi-vessel coronary disease and significant occlusive lesions.
- These findings suggest that patients with previous myocardial infarction and silent ischemia may represent a subgroup warranting surgical consideration.
- Routine Holter monitoring followed by angiography is recommended for accurate localization of obstructive lesions in this patient population.
Objective:
Our objective was to determine the presence of silent myocardial ischemia and the degree of coronary obstructions.
Design:
Successively patients with myocardial infarction.
Setting:
Patients admitted to the coronary intensive care, later followed in a specialised out-patients consultation.
Patients:
62 patients with previous myocardial infarction.
Interventions:
All the patients were submitted to Holter-monitoring and coronary angiography.
Results:
Silent ischemia was present in 14 (22,6%) of the patients. Seven of these (50%) had 3 vessels disease, 2 (14,3%) had 2 vessels disease, and 5 (35,7%) had 1 vessel disease. Twelve of the patients (86%) had occlusive lesions (greater than 90%), localised in 11 (79%) in the third proximal segment of the artery.
Conclusions:
Our results showed that the presence of silent myocardial ischemia was predominantly associated with 3 vessels disease, and with lesions of more than 90% of occlusion, localised in the 1/3 proximal of the vessel. Patients with previous myocardial infarction and silent ischemia may belong to a subgroup with surgical indication. And so, Holter studies in these patients should be followed by angiographic studies for localization of the obstructive lesions.