What question did this study set out to answer?

To compare exercise-induced angina and ST-segment depression as diagnostic markers for the presence and severity of coronary artery disease.

April 15, 1991Annals of Internal Medicine

Comparison of Silent and Symptomatic Ischemia during Exercise Testing in Men

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Why the study?

Does exercise-induced ST-segment depression or angina better predict the presence and severity of coronary artery disease in men?

Population

416 men referred for the evaluation of symptoms, postmyocardial infarction testing, or both at a U.S…

Design

Cohort

Authors

CMCres P. MirandaHospital Universitario Fundación Jiménez Díaz KLKenneth G. LehmannMedStar Washington Hospital Center BLBruce LachtermanTexas Medical Center

Discussion

Member takes

Implication

ST-segment depression may better indicate CAD than angina in men without prior MI; observational data leave open any change to exercise testing protocols.

Key Points

To compare exercise-induced angina and ST-segment depression as diagnostic markers for the presence and severity of coronary artery disease.
Retrospective analysis of 416 men (200 without previous myocardial infarction and 216 post-myocardial infarction survivors) evaluated at a Veterans Affairs medical center.
All patients underwent standard exercise testing and diagnostic coronary angiography with ventriculography within an average of 32 days (range, 0 to 90 days).
In men without prior myocardial infarction, exercise-induced ST-segment depression was a better marker for coronary artery disease than angina alone (P < 0.005), and symptomatic ischemia had a higher prevalence of severe disease than silent ischemia (30% vs 20%; 95% CI, -7.3% to 27.0%; P = 0.005).
In survivors of myocardial infarction, ST-segment depression was a better marker for severe coronary disease than angina alone (P = 0.08), with severe disease prevalence rates of 10% in no ischemia, 9% in angina only, 23% in silent ischemia, and 32% in combined ST depression and angina (P < 0.01).

Structured PICO

Does exercise-induced ST-segment depression or angina better predict the presence and severity of coronary artery disease in men?

Population

416 men referred for the evaluation of symptoms, postmyocardial infarction testing, or both at a U.S. Veterans Affairs medical center. 200 had no previous myocardial infarction, and 216 were survivors of a previous myocardial infarction.

Intervention

Standard exercise test and diagnostic coronary angiography with ventriculography within an average of 32 days

Outcome

Presence of any coronary artery disease and severe coronary artery diseasesurrogate

Exercise-induced ST-segment depression is a superior marker for the presence of coronary artery disease compared to exercise-induced angina, although symptomatic ischemia is associated with more severe disease.

Cite This Study

Miranda et al. (1991) studied this question.

synapsesocial.com/papers/6a6fc90b6c240de38cdb9587 https://doi.org/10.7326/0003-4819-114-8-649

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Implication

ST-segment depression may better indicate CAD than angina in men without prior MI; observational data leave open any change to exercise testing protocols.

Comparison of Silent and Symptomatic Ischemia during Exercise Testing in Men

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Comparison of Silent and Symptomatic Ischemia during Exercise Testing in Men

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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