Document Detail

Value of ambulatory ST segment monitoring in patients with chronic stable angina: does measurement of the "total ischaemic burden" assist with management?
MedLine Citation:
PMID:  1739525     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To assess the prognostic significance of transient ischaemic episodes during daily activities in patients with stable angina. PATIENTS AND METHODS: 172 patients with stable angina attending the cardiac outpatients departments of Hillingdon Hospital (n = 155) and the National Heart Hospital (n = 17) were prospectively studied by exercise testing and 48 hours of ambulatory ST segment monitoring, and followed for prognostic purposes for up to 39 months (mean 24.5 months). Patient inclusion depended on a clinical diagnosis of stable coronary artery disease which necessitated outpatient review (and antianginal treatment in 94% of patients). It was not dependent on objective evidence of reversible ischaemia. Events recorded during the follow up period included death, non-fatal myocardial infarction, unstable angina, and the requirement for revascularisation. RESULTS: 72 patients (42%) had transient ischaemic episodes during daily activities, and 104 patients (60.5%) had an ischaemic response to exercise. 63 patients (36%) had evidence of ischaemia on both investigations; with 59 (34%) having no documented ischaemia on either investigation. There were 27 patient events (15.7%) recorded over a mean 24.5 month follow up, including five deaths (2.9%) (three cardiac related (1.7%)), six non-fatal myocardial infarctions (3.5%), six admissions with unstable angina (3.5%), and 10 revascularisation procedures (5.8%). Of the nine "hard" or objective end points (cardiac death and non-fatal myocardial infarction), only two had evidence of transient ischaemia on ambulatory ST segment monitoring at initial investigation, with 10 of the 25 patients (38.5%) with any cardiac event having such episodes. CONCLUSIONS: The outcome in patients with chronic stable angina receiving standard medical treatment was good over a mean two year follow up period. For the purpose of assessing prognosis over this time scale, there was no advantage to performing ambulatory ST segment monitoring in such patients.
D Mulcahy; J Parameshwar; D Holdright; C Wright; J Sparrow; G Sutton; K M Fox
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  British heart journal     Volume:  67     ISSN:  0007-0769     ISO Abbreviation:  Br Heart J     Publication Date:  1992 Jan 
Date Detail:
Created Date:  1992-03-25     Completed Date:  1992-03-25     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  0370634     Medline TA:  Br Heart J     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  47-52     Citation Subset:  AIM; IM    
Royal Brompton National Heart and Lung Hospital, London.
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MeSH Terms
Angina Pectoris / complications,  drug therapy,  physiopathology*
Coronary Disease / complications,  physiopathology*
Electrocardiography, Ambulatory*
Exercise Test
Follow-Up Studies
Heart / physiopathology*
Middle Aged
Myocardial Infarction / complications
Prospective Studies

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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