Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-27T11:33:49.302Z Has data issue: false hasContentIssue false

Noninvasive Testing of Asymptomatic Patients for the Detection of Silent Ischemia After an Infarction: A Decision Analysis

Published online by Cambridge University Press:  10 March 2009

Joseph Lau
Affiliation:
Department of Veterans Affairs Medical Center
Miriam E. Adams
Affiliation:
Harvard School of Public Health

Abstract

This decision analysis estimates the overall gain in life expectancy and the relative efficacy of predischarge submaximal exercise electrocardiography, ambulatory cardiac monitoring, and thallium-201 scintigraphy for the identification of silent ischemia in asymptomatic postinfarct patients. A small, virtually equal increase in life expectancy can be obtained from any of the noninvasive tests (as compared to no testing). Large differences in life expectancy may result only when the prevalence of residual coronary artery disease and the probability of left-main and three-vessel lesions are high.

Type
General Essays
Copyright
Copyright © Cambridge University Press 1993

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Beck, J. R., Kassirer, J. P., & Pauker, S. G.A convenient approximation of life expectancy (the “DEALE"). I. Validation of the method. American Journal of Medicine, 1982, 70, 883–88.CrossRefGoogle Scholar
2.Beller, G. A.Myocardial perfusion imaging for detection of silent myocardial ischemia. American Journal of Cardiology, 1988, 61, 22F–26F.CrossRefGoogle ScholarPubMed
3.Berliner, U., Landry, F., Jette, M., & Blumchen, G.Silent ischaemia in post-infarction patients: A 21 month follow-up study. European Heart Journal, 1987, 8 (suppl. G), 131–35.CrossRefGoogle ScholarPubMed
4.Bertrand, M. E., Lefebvre, J. M., Laisne, C. L., et al. Coronary arteriography in acute transmural myocardial infarction. American Heart Journal, 1979, 97, 6169.Google Scholar
5.Betriu, A., Castaner, A., Sanz, G. A., et al. Angiographic findings 1 month after myocardial infarction: A prospective study of 259 survivors. Circulation, 1982, 65, 1099–1105.Google Scholar
6.Bleske, B. E., & Shea, M. J.Current concepts of silent myocardial ischemia. Clinical Pharmacy, 1990, 9, 339–57.Google Scholar
7.Campbell, S., Barry, J., Rocco, M. B., et al. Features of the exercise test that reflect the activity of ischemic heart disease out of hospital. Circulation, 1986, 74, 7280.CrossRefGoogle ScholarPubMed
8.Cohn, P. F.Silent myocardial ischemia: An update. Advances in Internal Medicine, 1989, 34, 377–92.Google ScholarPubMed
9.Conti, C. R.Silent myocardial ischemia: Prognostic significance and therapeutic implications. Clinical Cardiology, 1988, 11, 807–11.CrossRefGoogle ScholarPubMed
10.Crawford, M. H., Mendoza, C. A., O'Rourke, R. A., et al. Limitations of continuous ambulatory electrocardiogram monitoring for detecting coronary artery disease. Annals of Internal Medicine, 1978, 89, 15.Google Scholar
11.Detrano, R., Janosi, A., Lyons, K. P., et al. Factors affecting sensitivity and specificity of a diagnostic test: The exercise thallium scintigram. American Journal of Medicine, 1988, 84, 699710.CrossRefGoogle ScholarPubMed
12.Feldman, T., & Resnekov, L.Ambulatory ECG recording for detecting silent myocardial ischemia. Cardiovascular Clinics, 1988, 18, 2341.Google Scholar
13.Gianrossi, R., Detrano, R., Mulvihill, D., et al. Exercise-induced ST depression in the diagnosis of coronary artery disease. A meta-analysis. Circulation, 1989, 80, 8798.Google Scholar
14.Gottlieb, S. H., Gerstenblith, G., Achuff, S. C., et al. Ischemia ST segment changes by ambulatory Holter predict 1 year mortality in high risk post-infarct patients (Abstract). Circulation, 1986, 74, 1158.Google Scholar
15.Hecht, H. S., Shaw, R. E., Bruce, T., & Myler, R. K.Silent ischemia: Evaluation by exercise and redistribution tomographic thallium-201 myocardial imaging. Journal of the American College of Cardiology, 1989, 14, 895900.Google Scholar
16.Hinderliter, A. L., Herbst, M. C., Bragdon, E. E., et al. Silent myocardial ischemia during daily activities: Relationship to results of exercise testing and coronary angiography. Israel Journal of Medical Sciences, 1989, 25, 520–24.Google Scholar
17.Josephson, M. A., Nademanee, K., Intarachot, V., et al. Abolition of Holter monitor-detected silent myocardial ischemia after percutaneous transluminal coronary angioplasty. Journal of the American College of Cardiology, 1987, 10, 499503.Google Scholar
18.Kunkes, S. H., Pichard, A. D., Smith, H. Jr., et al. Silent ST segment deviations and extent of coronary artery disease. American Heart Journal, 1980, 100 (6 Pt 1), 813–20.Google Scholar
19.Morris, D. D., Rozanski, A., Berman, D. S., et al. Noninvasive prediction of angiographic extent of coronary artery disease after acute myocardial infarction: Comparison of clinical, bicycle exercise, electrocardiographic and ventriculographic parameters. Circulation, 1984, 70, 192201.Google Scholar
20.Moskowitz, R. M., Chatterjee, K., & Parmley, W. W.Silent myocardial ischemia: An update. Medical Clinics of North America, 1988, 72, 1033–54.Google Scholar
21.Ouyang, P., Shapiro, E. P., Chandra, N. C., et al. An angiographic and functional comparison of patients with silent and symptomatic treadmill ischemia early after myocardial infarction. American Journal of Cardiology, 1987, 59, 730–34.Google Scholar
22.Pepine, C. J.Is silent ischemia a treatable risk factor in patients with angina pectoris? Circulation, 1990, 82(suppl. II), II 135–42.Google Scholar
23.Quyyumi, A. A., Mockus, L., Wright, C., & Fox, K. M.Morphology of ambulatory ST segment changes in patients with varying severity of coronary artery disease. Investigation of the frequency of nocturnal ischaemia and coronary spasm. British Heart Journal, 1985, 53, 2, 186–93.CrossRefGoogle ScholarPubMed
24.Rahimtoola, S. H.Are the findings from the randomized coronary artery surgery study (CASS) of value in the management of patients soon after acute myocardial infarction? American Journal of Cardiology, 1985, 56, 179–81.Google Scholar
25.Roubin, G. S., Harris, P. J., Bernstein, L., & Kelly, D. T.Coronary anatomy and prognosis after myocardial infarction in patients 60 years of age and younger. Circulation, 1983, 67, 743–49.Google Scholar
26.Rozanski, A., & Berman, D. S.Silent myocardial ischemia. I. Pathophysiology, frequency of occurrence, and approaches toward detection. American Heart Journal, 1987, 114, 615–26.Google Scholar
27.Schulman, S. P., Achuff, S. C., Griffith, L. S., et al. Prognostic cardiac catheterization variables in survivors of acute myocardial infarction: A five year prospective study. Journal of the American College of Cardiology, 1988, 11, 1164–72.Google Scholar
28.Theroux, P., Waters, D. D., Halphen, C., et al. Prognostic value of exercise testing soon after myocardial infarction. New England Journal of Medicine, 1979, 301, 341–45.Google Scholar
29.Turner, J. D., Rogers, W. J., Mantle, J. A., et al. Coronary angiography soon after myocardial infarction. Chest, 1980, 77, 5864.Google Scholar
30.Tzivoni, D., Gavish, A., Zin, D., et al. Prognostic significance of ischemic episodes in patients with previous myocardial infarction. American Journal of Cardiology, 1988,62,661–64.Google Scholar
31.von Arnim, T., Szeimies-Seebach, U., Erath, A., et al. Ischemia on ambulatory monitoring: Has it prognostic implications? Advances in Cardiology, 1990, 37, 236–43.Google Scholar
32.Wong, J. B., Sonnenberg, F. A., Salem, D. N., & Pauker, S. G.Myocardial revascularization for chronic stable angina. Annals of Internal Medicine, 1990, 113, 852–71.Google Scholar
33.Yeung, A. C., Barry, J., & Selwyn, A. P.Silent ischemia after myocardial infarction: Prognosis, mechanism, and intervention. Circulation, 1990, 82(suppl. II), S143–48.Google ScholarPubMed