ABSTRACT
PURPOSE: To evaluate whether the number and duration of the episodes of silent myocardial ischemia increase with aging of patients. METHODS: A Holter monitoring, with CardioData equipment, was made in 1,300 patients and 330 with proven significant coronary obstructions were selected for this study. The anti-anginal medication was maintained during the 24 or 48 hours of Holter recording. The patients were arbitrarily divided into four groups according to age less than 50 years, 50 to 59 years, 60 to 69 years and greater than or equal to 70 years old. The statistical analysis was made with two models, the model of logistic regression and the Poisson model. RESULTS: Myocardia ischemia was detected in 72 patients (21.8%), 55 (76%) had only silent episodes, 6 (9%) had only anginal ischemia and 11 patients (155) had both silent and anginal ischemia. There was a progressive increase in the number and duration of the episodes of myocardial ischemia with aging. The proportion of patients with episodes of myocardial ischemia in the 4 age groups was 12.12%, 19.75%, 22.25% and 31.48% and the duration of the episodes of ischemia per patient 37, 37.5, 50.8 and 85.1 minutes, respectively. Statistical analysis showed a significant increase with aging in number and duration of the episodes. CONCLUSIONS: Myocardial ischemia is still present in asymptomatic patients during anti-anginal treatment and the ischemia is mainly silent. There is a progressive increase with aging in number and duration of the episodes of ischemia.
Subject(s)
Angina Pectoris/diagnosis , Coronary Disease/complications , Age Factors , Aged , Angina Pectoris/epidemiology , Electrocardiography, Ambulatory , Female , Humans , Incidence , Male , Middle Aged , PrognosisABSTRACT
A 24-hour recording of ambulatory EKG (Holter) was obtained in 159 patients with coronary disease: previous myocardial infarction (n = 76), myocardial revascularization (n = 66), severe obstruction during cine-coronarography (n = 13) or during coronary angioplasty (n = 4). Prophylactic anti-anginal drugs were maintained during the Holter and, despite the medication, transitory episodes of myocardial ischemia (MI) were recorded in 51 patients (32%), either with angina (AMI) or silent (SMI), isolated SMI was recorded in 44 patients (86%), 6 subjects had both SMI (16 episodes) and AMI (12 episodes) and one patient had only one episode of AMI. There was a total of 119 episodes of MI, 106 of SMI (89.1%) and 13 AMI (10.9%). The total duration of the episodes of SMI per patient varied from 1 min to 235 min and the IMS maximal duration was 221 min. In the six cases with both SMI and AMI, the total duration of SMI was 461 min and AMI was 306 min. The circadian distribution of the episodes of SMI was: from 12:00 to 18:00-31.4%, 18:00 to 24:00-27.6%, 0:00 to 6:00-7.7% and 6:00 to 12:00-33.3%. The SMI activity was recorded in 89 episodes-23.6% during sleep, 22.4% at rest, 46% during physical activity and 8% during other activities. The mean ST segment depression during SMI (n = 106) was of -2.25 mm and during AMI (n = 13) was of -3.25 mm.(ABSTRACT TRUNCATED AT 250 WORDS)
