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Long-term prognosis of transient acute myocardial ischemia at rest
S Severi1, C Michelassi, E Orsini
1National Research Council, University of Pisa, Italy.
Insights
Patients with myocardial ischemia at rest have a poor long-term prognosis, with survival predicted by factors like electrocardiogram abnormalities and coronary artery disease severity. These noninvasive and invasive characteristics help determine the risk of death.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- A medical approach was used for 652 patients with myocardial ischemia at rest.
- No immediate coronary revascularization was performed; only 13% had bypass surgery within 8 months post-discharge.
Purpose of the Study:
- To identify predictors of long-term mortality in patients with myocardial ischemia at rest.
- To assess the relationship between noninvasive and invasive factors and patient survival.
Main Methods:
- Retrospective analysis of 652 patients with myocardial ischemia at rest.
- Univariate and Cox survival analyses were used to identify significant predictors of mortality.
- Invasive characteristics were analyzed to determine additive prognostic variables.
Main Results:
- The 10-year mortality rate was 28% overall and 20% for cardiac causes.
- Significant univariate predictors included abnormal basal electrocardiogram, coronary artery disease duration, prior myocardial infarction, ST-T wave changes, age, and hypertension.
- Independent predictors identified by Cox analysis were abnormal basal electrocardiogram, coronary artery disease duration, and ST-T wave changes. Invasive factors like narrowed coronary arteries and ejection fraction also predicted outcomes.
Conclusions:
- Long-term prognosis for patients with myocardial ischemia at rest is significantly influenced by the severity of coronary artery disease and left ventricular function.
- Abnormal basal electrocardiogram and coronary artery disease duration are key independent predictors of mortality.
- The pattern of ST-T changes during ischemia is a predictor, but prognosis is primarily linked to anatomical impairment.
Abstract:
A medical approach to treatment was adopted in 652 patients with documented myocardial ischemia at rest during both the acute and follow-up phases. No patient underwent coronary revascularization during hospitalization and only 86 patients (13%) underwent coronary bypass surgery within 8 months from discharge. During hospitalization 13 patients died. In the remaining group (639 patients), the likelihood of death in the 10-year period after discharge was 28% for all patients and 20% for cardiac causes only. A series of factors studied during the acute stage were assessed in an effort to predict long-term outcome. The following noninvasive characteristics, listed in decreasing order of statistical significance, were found to be significant univariate predictors of survival: abnormal basal electrocardiogram, duration of coronary artery disease, previous myocardial infarction, pattern of ST-T changes during episodes of ischemia at rest, age and systemic hypertension. The average annual mortality rate for patients with T-wave changes, ST-segment elevation and ST-segment depression was 0.9, 1.8 and 3%, respectively. The Cox survival analysis identified abnormal basal electrocardiogram, duration of coronary artery disease and pattern of ST-T changes as significant, independent predictors of death. When invasive characteristics were entered in the model, number of greater than or equal to 50% narrowed coronary arteries, left ventricular ejection fraction, abnormal basal electrocardiogram and smoking habit were found to be independent and additive prognostic variables. Thus, long-term prognosis of patients with ischemia at rest is related to the severity of anatomic impairment, independent of the pattern of ST-T changes observed during the acute phase.(ABSTRACT TRUNCATED AT 250 WORDS)