MULTICENTER STUDY OF SILENT MYOCARDIAL ISCHEMIA

拟议的研究是一项前瞻性的多中心研究，以 确定无症状性ST段压低(ASTD)是否在动态 心电记录(所谓的静默心肌 缺血)与心脏病风险的增加有关 年随访1-3年期间的死亡率和发病率事件 已确诊的冠心病患者。一千 患者将在住院后2至6个月登记参加 一次急性冠脉事件。这些患者将来自 地理上分散的参与中心(美国有10个，1个 在加拿大和以色列)，以加强对 结果给总体处于危险中的人群造成了影响。24小时不间断服务 将利用心电记录来评估 ASTD作为静默标记物的频率、严重程度和持续时间 日常活动中的心肌缺血。这 信息将结合ST段进行分析 跑台运动抑制，可逆性心肌灌注 应力铊测试上的缺陷，以及有限数量的 预先指定的临床参数以评估其贡献 ASTD增加了从Current确定的预测信息 用于评估心肌缺血的诊断技术。 数据分析的主要主旨是：1)评估 ASTD在门诊中的预测性有用性和独立性 已确诊的冠心病患者；2)评估 频度、严重程度、 ASTD持续时间及其他心肌缺血指标；3) 以深入了解可疑的血管活性(供应)并增加 心肌耗氧(需)机制的研究进展 以及4)更好地理解脑缺血和脑缺血之间的相互关系 心肌缺血与室性心律失常的关系 随后的心脏死亡率和发病率事件。

The proposed research is a prospective multicenter study to determine if asymptomatic ST depression (ASTD) on ambulatory electrocardiographic recordings (so-called silent myocardial ischemia) is associated with an increased risk of cardiac mortality and morbidity events during a 1 to 3-year follow-up in patients with established coronary heart disease. One thousand patients will be enrolled 2 to 6 months after hospitalization for an acute coronary event. The patients will be derived from geographically dispersed participating centers (10 in the U.S., 1 in Canada, and 1 in Israel) to enhance generalization of the results to the overall population at risk. Ambulatory 24-hour electrocardiographic recordings will be utilized to evaluate the frequency, severity, and duration of ASTD as a marker of silent myocardial ischemia during usual daily activities. This information will be analyzed in conjunction with ST segment depression on treadmill exercise, reversible myocardial perfusion defects on stress thallium testing, and a limited number of prespecified clinical parameters to assess the contribution which ASTD adds to prognostic information ascertained from current diagnostic techniques used to evaluate myocardial ischemia. The main thrusts of the data analyses are: 1) to assess the predictive usefulness and independence of ASTD in ambulatory patients with established coronary heart disease; 2) to evaluate the interactions and associations between the frequency, severity, and duration of ASTD and other measures of myocardial ischemia; 3) to obtain insight into suspected vasoactive (supply) and increased myocardial oxygen consumption (demand) mechanisms of myocardial ischemia; and 4) to better understand the interrelationship between myocardial ischemia and ventricular arrhythmias as it relates to subsequent cardiac mortality and morbidity events.