PROGNOSIS OF AMBULATORY SILENT ISCHEMIA

冠心病患者的无症状心肌缺血是一种 一种状态，其特征是心脏的不平衡 对氧气的需求和氧气的供应。在短暂的情况下，这 供需失衡会导致胸痛或心绞痛，但 它常常是寂静的。静止性缺血发作可以通过以下方式检测到 动态心电图对ST段的连续监测 监控。一些报道表明，沉默的存在 动态心电图上的缺血确定了高危亚群的患者 冠状动脉疾病。我们已经调查了两年的结果 在解剖和功能性低风险亚群中存在无症状性缺血 95名冠心病患者，并与17名 高危组患者(有严重多支冠状动脉病变的患者 动脉疾病和/或左心功能不全)。几乎一半的人 低风险患者和三分之二的高风险患者 亚组在日常活动中有静止性脑缺血。心肌梗死 2.5%的Holter阳性患者和11%的Holter阳性患者发生不稳定型心绞痛 低风险亚组中Holter阴性的患者。区别在于 在统计学上并不显著。然而，在高风险人群中，45% 8%的患者在Holter阳性组中发生事件。因此，可移动的 脑缺血只在那些传统意义上 已知处于高风险，尽管经常处于低风险状态 亚组中，它与不良的中期预后无关。

Silent myocardial ischemia in patients with coronary artery disease is a condition which is characterized by an imbalance between the heart's requirement for oxygen and the supply of oxygen. When transient, this imbalance between supply and demand results in chest pain or angina, but it is often silent. Episodes of silent ischemia can be detected by continuous electrocardiographic monitoring of the ST segment using Holter monitoring. Some reports have suggested that the presence of silent ischemia on Holter identifies a high risk subgroup of patients with coronary artery disease. We have investigated the 2 year outcome of the presence of silent ischemia in an anatomic and functional low-risk subset of 95 patients with coronary artery disease and compared them with 17 patients in a high risk subset (those who had severe multivessel coronary artery disease and/or left ventricular dysfunction). Almost half the patients in the low risk and two-thirds of the patients in the high risk subsets had silent ischemia during daily activities. Myocardial infarction or unstable angina occurred in 2.5% of Holter positive patients and 11% of patients who were Holter negative in the low risk subset. The difference was not statistically significant. However, in the high risk subset, 45% of patients had events in the Holter positive group. Thus, ambulatory ischemia indicates a worse outcome only in patients who are conventionally known to be in high risk, and although frequently present in low risk subsets, it is not associated with an adverse medium term prognosis.