PROGNOSIS OF AMBULATORY SILENT ISCHEMIA

冠状动脉疾病患者无症状心肌缺血是一种 这种情况的特点是心脏的不平衡， 对氧气的需求和氧气的供应。 当瞬态时， 供需失衡导致胸痛或心绞痛，但 它常常是沉默的。 无症状性缺血发作可通过以下方法检测： 使用霍尔特对ST段进行连续心电图监测 监测.一些报告表明，沉默的存在 霍尔特显示的缺血可识别出以下患者的高风险亚组： 冠心病 我们已经调查了2年的结果， 解剖学和功能性低风险亚组中存在无症状性缺血 95例冠心病患者与17例正常对照组比较， 高风险亚组中的患者（患有严重多支冠状动脉病变的患者） 动脉疾病和/或左心室功能障碍）。 几乎一半的 低风险患者和三分之二的高风险患者 亚组在日常活动中无症状性缺血。 心肌梗死 霍尔特阳性患者中2.5%和11%的患者发生了心绞痛或不稳定型心绞痛。 低风险亚组中霍尔特阴性的患者。 的差异 没有统计学意义。 然而，在高风险子集中，45% 的患者在霍尔特阳性组中发生事件。 因此， 缺血仅在常规治疗的患者中显示更差的结果。 已知处于高风险中，尽管经常存在于低风险中， 亚群，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.