MULTICENTER STUDY OF SILENT MYOCARDIAL ISCHEMIA

拟议的研究旨在前瞻性地全面分析 多中心研究中973例入组患者的累积数据， 无症状性心肌缺血（MSSMI）。 主要目标是确定 动态心电图的有用性或缺乏有效性 （AECG）监测以识别具有危险的冠状动脉患者 缺血性心肌有缺血性心脏事件的风险。 的目的 这项资助是：1）评估现有方法的重现性 用于检测AECG上的缺血型变化（ST段压低）; 2） 提高当代扫描仪的准确性和可靠性-互动 我们和其他人一直在使用的方法， AECG上缺血型ST段改变; 3）完成 开发一种新的，创新的，可复制的基于计算机的 自动（独立于操作员）、定量 MSSMI上逐搏缺血型ST段压低的识别 4）评价改良和新AECG磁带的临床应用价值 ST段分析技术用于识别冠心病患者的风险 自然心脏事件（不稳定型心绞痛，非致命性心肌梗死， 和心源性死亡） 人口，在选定的亚组（性别，年龄），并在预先规定的 高风险缺血子集;和5）确定最佳成本- 有效的战略排序评估沉默，危及 缺血心肌的临床变量和非侵入性测试， 确定冠心病患者是否存在后续缺血性心脏病风险 事件 这项研究将利用统计技术来评估 在AECG上检测ST压低的再现性（kappa统计， 方差分析，Cochran’s Q检验），用于确定缺血风险 至心脏事件时间的因素（考克斯回归分析），以及 成本效益分析（受试者-操作者特征曲线）。 了解心肌缺血的基础，无症状或有症状， 是对用于检测它的技术的有效性的了解， 在一个明确定义的，有代表性的 冠状动脉人群，缺血试验阳性的预测价值， 人群和临床相关亚组。 的信息 从这个研究计划的分析阶段得出的结论应该会有所改善， 缺血性心脏病患者的诊断和治疗。

The proposed research is designed to fully analyze the prospectively accumulated data on 973 enrolled patients in the Multicenter Study of Silent Myocardial Ischemia (MSSMI). The primary goal is to determine the usefulness, or the lack thereof, of ambulatory electrocardiographic (AECG) monitoring for identifying coronary patients with jeopardized ischemic myocardium at risk for ischemic cardiac events. The aims of this grant are: 1) to evaluate the reproducibility of current methods for detecting ischemic-type changes (ST depression) on AECG; 2) to improve the accuracy and reliability of contemporary scanner-interactive methodology that we and others have been utilizing for identifying ischemic-type ST-segment changes on the AECG; 3) to complete the development on a new, innovative, and reproducible computer-based technique for automatic (operator-independent), quantitative identification of beat-to-beat ischemic-type ST depression on the MSSMI AECG tapes; 4) to evaluate the clinical utility of the improved and new ST-segment analytic techniques to identify coronary patients at risk for natural cardiac events (unstable angina, non-fatal myocardial infarction, and cardiac death) during 2-year follow-up in the overall MSSMI population, in selected subgroups (gender, age), and in prespecified high-risk ischemic subsets; and 5) to determine the optimal cost- effective strategy for sequencing the assessment of silent, jeopardized ischemic myocardium by clinical variables and non-invasive tests to identify coronary patients at risk for subsequent ischemic cardiac events. This research will utilize statistical techniques for evaluating reproducibility of detecting ST depression on AECG (kappa statistics, analyses of variance, Cochran's Q-test), for determining ischemic risk factors for time-to-cardiac events (Cox regression analyses), and for cost-effectiveness analyses (receiver-operator characteristic curves). Basic to an understanding of myocardial ischemia, silent or symptomatic, is knowledge of the effectiveness of the technologies used to detect it, the true prevalence of ischemia in a well defined, representative coronary population, and predictive value of a positive ischemic test in the population and in clinically relevant subsets. The information derived from the analytic phase of this research program should improve the diagnosis and management of patients with ischemic heart disease.