Key Points
- To determine the frequency, circadian distribution, and clinical characteristics of silent myocardial ischaemia in patients with chronic stable angina and documented coronary artery disease.
- Monitored 150 unselected patients with documented coronary artery disease after withdrawing routine antianginal medications.
- Performed continuous ambulatory ST segment monitoring (totaling 6,264 hours) and symptom-limited treadmill exercise testing (n = 146).
- Significant ST segment changes occurred in 91 patients (61%) across 598 total episodes, of which 446 (75%) were entirely asymptomatic (silent).
- Silent ischaemia distribution was heavily skewed, with 11 patients (7%) accounting for 50% of all silent episodes and 48 patients (32%) accounting for 91%, showing a daytime peak between 0730 and 1930.
- Silent ischaemia occurred significantly more often in patients with three-vessel disease versus single-vessel disease and strongly correlated with positive exercise test parameters, with no associated ventricular tachycardia.
Structured PICO
PPopulation150 unselected patients with documented coronary artery disease and chronic stable angina
OOutcomeFrequency and characteristics of silent myocardial ischaemia (significant ST segment changes)surrogate
Silent myocardial ischemia is highly prevalent in patients with chronic stable angina, accounting for 75% of ischemic episodes, and is more frequent in those with severe multi-vessel disease.