PROGNOSTIC IMPORTANCE OF MYOCARDIAL ISCHEMIA

冠状动脉疾病的许多损害性临床特征可以是 无症状或无预警地出现。 活动性心肌缺血是 冠状动脉粥样硬化的重要功能表达， 是这些临床表现的基础。在医院进行的测试旨在 在评估风险时可以测量心肌缺血的活动性 但在日常生活中不考虑局部缺血。 心电图 对明显稳定的非卧床患者的监测显示， 无症状性心肌缺血，有许多新的特征未见 在医院进行的测试中（例如，事件大多数是无症状的， 令人惊讶地延长，与压力无关，并显示出昼夜节律 与心肌梗死报告的情况类似）。 本研究旨在 量化非卧床患者的心肌缺血活动， 冠状动脉疾病的医院，以：a）研究 与冠状动脉病变发生相关的缺血自然史 事件; B）检查院外所有活动性缺血对 c）确定活动性缺血的监测是否提供了 关于冠状动脉事件风险的增量信息 试验. 一项前瞻性研究n例连续患者将描述 他们根据历史，症状，危险因素，运动测试， 心肌缺血和心导管检查数据。 连续48小时 调频动态心电图监测将 在基线和6个月时接受和不接受标准药物治疗 的间隔 所有活动性缺血的频率和持续时间 医院将在多变量分析中与症状、临床 和实验室数据，以及冠状动脉事件的发生， 死亡、心肌梗死、因不稳定型心绞痛住院治疗， 需要进行血运重建。 该项目的长期目标是： a）测试所有医院外缺血的重要性， 冠心病稳定患者作为未来风险的衡量标准 冠状动脉事件比常规测试更具鉴别力， B）提供客观的方法来评估影响 新的疗法。 院外动态监测显示， 无症状性缺血是常见的和忽视的管理 冠状动脉疾病的稳定患者。 如果活动 缺血影响预后，可能不足以治疗症状 单独和新的目标可能是必要的，旨在控制所有活动 日常生活中的局部缺血

Many of the damaging clinical feature of coronary artery disease can be asymptomatic or present without warning. Active myocardial ischemia is an important functional expression of coronary atherosclerosis and underlies most of these clinical manifestations. Tests in hospital aimed at the assessment of risk can measure the activity of myocardial ischemia but do not consider ischemia during daily life. Electrocardiographic monitoring in apparently stable ambulatory patients has shown frequent asymptomatic myocardial ischemia with many new characteristics not seen in tests performed in hospital (e.g., events are mostly asymptomatic, surprisingly prolonged, not related to stress and show a diurnal rhythm similar to that reported for myocardial infarction). This study aims to quantify the activity of myocardial ischemia in ambulatory patients with coronary artery disease out of the hospital in order to: a) study the natural history of ischemia in relation to the occurrence of coronary events; b) examine the effects of all active ischemia out of hospital on prognosis; and c) to establish if monitoring of active ischemia provides incremental information about risk of coronary events a[art from usual testing. A prospective study n consecutive patients will characterize them according to history, symptoms, risk factors, exercise testing for myocardial ischemia and cardiac catheterization data. Serial 48-hour frequency modulated ambulatory monitoring of the electrocardiogram will be performed on and off standard medication at baseline and at 6 month intervals. The frequency and duration of all active ischemia out of the hospital will be related in a multivariate analysis to symptoms, clinical and laboratory data, and to the occurrence of coronary events such as death, myocardial infarction, hospitalization for unstable angina and the need for revascularization. The long-term aims of this project are to: a) test the importance of all ischemia out of hospital in apparently stable patients with coronary disease as a measure of risk for future coronary events that is more discriminating than conventional testing in hospital, and b) to provide an objective means for assessing the effects of new therapies. Out of hospital ambulatory monitoring has shown that asymptomatic ischemia is common and overlooked in the management of apparently stable patients with coronary disease. If the activity of ischemia affects prognosis, it may not be sufficient to treat symptoms alone and new goals may be necessary that aim to control all active ischemia during daily life.