Key Points
- To evaluate the clinical patterns, diagnostic sensitivity, and prognostic significance of transient myocardial ischemia detected by ambulatory ST-segment monitoring after acute myocardial infarction.
- Reviewed clinical evidence evaluating ambulatory continuous ST-segment monitoring compared with exercise stress testing in survivors of acute myocardial infarction.
- Examined ischemic patterns across clinical subsets, including non-Q wave infarction, patients treated with thrombolytic therapy, and varying degrees of left ventricular dysfunction.
- Post-infarction transient ischemia shows a lower overall frequency than in chronic stable coronary disease but features a higher proportion of asymptomatic (silent) episodes, with peak activity in the late evening.
- Ischemia occurs more commonly after non-Q wave infarction, decreases following thrombolysis, and demonstrates a poor correlation with severe left ventricular dysfunction.
- Exercise testing demonstrates superior diagnostic sensitivity compared to ambulatory monitoring, and evidence remains conflicted regarding how ambulatory ischemic episodes predict specific future cardiac events.
Structured PICO
PPopulationSurvivors of acute myocardial infarction
IInterventionAmbulatory ST-segment monitoring
While ambulatory ST-segment monitoring can detect silent and transient ischemia post-myocardial infarction and provide prognostic information, its routine clinical utility remains undefined.