PROGNOSTIC INDICATORS OF MAJOR CARDIAC EVENTS IN PATIENTS WITH ASYMPTOMATIC CORONARY-ARTERY DISEASE

We investigated the role of myocardial ischemia in acute myocardial in farction and cardiac death in 253 patients with asymptomatic coronary disease (206 men, 47 women, mean age: 55 +/- 8 years). Patients were d ivided into two groups: those with angina pectoris with no history of myocardial infarction (AP group, 93 patients) and those with a history of myocardial infarction CMI group, 160 patients). We also examined t he usefulness of exercise electrocardiographic and Holter electrocardi ographic findings as prognostic indicators of cardiac events. After 24 -hour Holter electrocardiograms were obtained in both groups, patients were assigned to subgroups with or without silent myocardial ischemia (SMI) based on the presence or absence of transient ST-segment depres sion. Prognostic indicators were evaluated by multiple regression anal ysis. Cardiac events occurred in 26 (10.3%) of 253 patients; in 6 pati ents these events were fatal. The incidence of cardiac events was sign ificantly higher in the SMI group than in the non-SMI group (16.4% ver sus 5.6%, P < 0.05). SMI was identified as a significant prognostic in dicator in the overall population (p = 0.0088), as were the number of diseased coronary arteries in the AP group (P = 0.0152), and SMI (p = 0.0022) in the MI group. There were 3 deaths related to cardiac events in each group. The mean time from onset of angina pectoris to death w as 73 +/- 41 months compared with 33 +/- 43 months in the MI group. Ou r findings suggest that the severity of the coronary lesion and SMI we re important predictors of major cardiac events, and that the mechanis m of the onset of cardiac events was different in the AP and MI groups .