Prognostic value of ischemia during Holter monitoring and exercise testing after acute myocardial infarction

Jereczek, Matthias; Andresen, Dietrich; Schröder, Joachim; Völler, Heinz; Brüggemann, Thomas; Deutschmann, Christel; Schröder, Rolf

doi:10.1016/0002-9149(93)90210-4

Cited by 27 publications

(20 citation statements)

References 34 publications

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“…With regard to the convalescent phase of MI, silent ischemia is more frequent at this time than in the acute phase, but it seems its presence does not portend adverse outcome to the same extent, when restricted to death and MI. 33,34 Silent ischemia in the postinfarct phase does predict cardiac events when revascularization is included as an event, and although the prognostic importance of silent ischemia in the postinfarct phase is attenuated during long-term follow-up, the presence of silent ischemia remains predictive of all cardiac events up to 5 years after the index infarct. 35 When subjected to multivariate analysis, ambulatory ischemia fails to outperform clinical indices such as Killip class 36 in predicting acute events.…”

Section: Patients Who Have Had MImentioning

confidence: 99%

Silent Myocardial Ischemia

2003

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Section: Patients Who Have Had MImentioning

confidence: 99%

Silent Myocardial Ischemia

2003

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“…Ambulatory monitoring may supplement stress testing in risk stratification, but the exact, independent information from the presence of TMI remains debatable [3, 6, 8, 11, 13, 24]. The presence of TMI may identify patients at increased risk of reinfarction or cardiac death in AMI survivors unable to perform predischarge exercise testing [3, 5, 11].…”

Section: Discussionmentioning

confidence: 99%

“…Episodes of transient myocardial ischemia (TMI) can be detected in 14–42% of patients recovering from acute myocardial infarction (AMI), if ambulatory monitoring is performed <3 weeks after the index event [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11]. From prognostic studies available we know that TMI may be associated with an adverse clinical outcome [1, 2, 3, 5, 6, 7, 8, 10, 11].…”

Section: Introductionmentioning

confidence: 99%

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Serial Holter ST-Segment Monitoring after First Acute Myocardial Infarction

Mickley

Nielsen²,

Berning³

et al. 1998

Cardiology

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Based on serial Holter monitoring performed 7 times within 3 years after a first acute myocardial infarction, we assessed the prevalence, variability and long-term clinical importance of transient myocardial ischemia (TMI) defined as episodes of ambulatory ST-segment depression. In all, 121 consecutive male patients <70 years old were studied. The prevalence of TMI on different Holter recordings varied around 20% ranging between 18 and 27%. Fifty-five of the patients (46%) had TMI on at least 1 of the 7 Holter recordings. Considerable variability was found within and between patients for the presence of TMI. No high-risk group for cardiac death, nonfatal reinfarction or coronary revascularization during up to 10 years of follow-up could be identified by the detection of TMI. From these results we conclude that a routine search for TMI on serial Holter monitoring cannot be recommended in male survivors of an uncomplicated first acute myocardial infarction.

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“…Episodes of transient myocardial ischemia as judged from ST-segment depression on ambulatory monitoring has been demonstrated in 14-42% of patients recovering from a recent AMI [5][6][7][8][9][10][11][12][13][14][15][16] (table 1). The wide range of val ues reported probably reflects differences in selection of patients, number and site of electrocardiographic chan nels used, time and duration of monitoring, and criteria adopted for defining episodes of transient myocardial ischemia.…”

Section: Prevalence and Characteristics Of Transient Myocardial Ischemiamentioning

confidence: 99%

Transient Myocardial Ischemia after Myocardial Infarction

Mickley

1995

Cardiology

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Ambulatory ST-segment monitoring is a relatively new device in the evaluation of myocardial ischemia. The method is unique in allowing us to continuously examine the patient over an extended period of time in a changing environmental milieu. In survivors of acute myocardial infarction the prevalence of ambulatory or transient myocardial ischemia is lower than in patients with chronic, stable coronary artery disease. A greater proportion of ischemic episodes, however, are silent than in other subgroups with ischemic heart disease. Early after the infarction, transient myocardial ischemia exhibits a circadian variation with a peak activity occurring in the late evening hours. Patients with non-Q wave infarction have more transient myocardial ischemia, whereas thrombolytic therapy seems to result in less residual ischemia. Exercise testing is more sensitive than ambulatory monitoring in the detection of postinfarction myocardial ischemia. There appears to be a poor association between transient myocardial ischemia and severe left ventricular dysfunction. Transient myocardial ischemia has been shown to provide prognostic information in different subsets of patients with previous myocardial infarction, but there is considerable disagreement about how this is expressed in terms of cardiac events. The precise role of postinfarction ST-segment monitoring in clinical practice has yet to be established.

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Prognostic value of ischemia during Holter monitoring and exercise testing after acute myocardial infarction

Cited by 27 publications

References 34 publications

Silent Myocardial Ischemia

Silent Myocardial Ischemia

Serial Holter ST-Segment Monitoring after First Acute Myocardial Infarction

Transient Myocardial Ischemia after Myocardial Infarction

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