BACKGROUND: Little is known about incidence, threshold, and predictors of prognostically relevant silent ischemia (SI). The aim was to study these three aspects of silent coronary artery disease (CAD). METHODS: In total, 3,664 consecutive asymptomatic patients without prior diagnosis of CAD undergoing myocardial perfusion SPECT (MPS) were evaluated and followed-up > or = 1 year for Events (HE): cardiac death or myocardial infarction. MPS was interpreted using a 20 segment model to define summed stress, rest, and difference scores (the extent of % myocardium ischemic was derived). Prognostic high-risk ischemia was defined as ischemia consistent with a HE rate > or = 3%. RESULTS: Overall, > or = 7.5% myocardium ischemic was consistent with high risk. Twenty-one and six percent of patients had ischemia and high-risk ischemia, respectively. Patients with high-risk ischemia had a worse prognosis than patients with less SI, HE rate of 3.1 and 0.4%, respectively, (P = .0001). Sex, age, diabetes, hypertension, abnormal resting ECG, angina, peak heart rate, blood pressure during treadmill testing, ST-depression, and Duke treadmill score were independent predictors of relevant SI. CONCLUSIONS: In total, > or = 7.5% myocardium ischemic revealed to be consistent with high risk. Six percent of patients had evidence of high-risk SI. Diagnostic scores are provided to most likely identify patients with high-risk SI.
BACKGROUND: Little is known about incidence, threshold, and predictors of prognostically relevant silent ischemia (SI). The aim was to study these three aspects of silent coronary artery disease (CAD). METHODS: In total, 3,664 consecutive asymptomatic patients without prior diagnosis of CAD undergoing myocardial perfusion SPECT (MPS) were evaluated and followed-up > or = 1 year for Events (HE): cardiac death or myocardial infarction. MPS was interpreted using a 20 segment model to define summed stress, rest, and difference scores (the extent of % myocardium ischemic was derived). Prognostic high-risk ischemia was defined as ischemia consistent with a HE rate > or = 3%. RESULTS: Overall, > or = 7.5% myocardium ischemic was consistent with high risk. Twenty-one and six percent of patients had ischemia and high-risk ischemia, respectively. Patients with high-risk ischemia had a worse prognosis than patients with less SI, HE rate of 3.1 and 0.4%, respectively, (P = .0001). Sex, age, diabetes, hypertension, abnormal resting ECG, angina, peak heart rate, blood pressure during treadmill testing, ST-depression, and Duke treadmill score were independent predictors of relevant SI. CONCLUSIONS: In total, > or = 7.5% myocardium ischemic revealed to be consistent with high risk. Six percent of patients had evidence of high-risk SI. Diagnostic scores are provided to most likely identify patients with high-risk SI.
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Authors: E Gordon Depuey; John J Mahmarian; Todd D Miller; Andrew J Einstein; Christopher L Hansen; Thomas A Holly; Edward J Miller; Donna M Polk; L Samuel Wann Journal: J Nucl Cardiol Date: 2012-04 Impact factor: 5.952
Authors: Marco Matteo Ciccone; Artor Niccoli-Asabella; Pietro Scicchitano; Michele Gesualdo; Antonio Notaristefano; Domenico Chieppa; Santa Carbonara; Gabriella Ricci; Marco Sassara; Corinna Altini; Giovanni Quistelli; Mario Erminio Lepera; Stefano Favale; Giuseppe Rubini Journal: Vasc Health Risk Manag Date: 2011-03-04