SILENT-MYOCARDIAL-ISCHEMIA DURING EXERCISE TESTING - DOES IT INDICATEA DIFFERENT ANGIOGRAPHIC AND PROGNOSTIC SYNDROME

The prognostic significance of silent myocardial ischemia detected dur ing graded exercise testing (GXT) is uncertain. The angiographic chara cteristics and long-term follow-up of 83 patients with silent ischemia (group 1), mean age 58 +/- 9 years, were compared with 83 age and sex -matched patients with typical angina pectoris (group 2). Basic charac teristics and mean follow-up (42 +/- 22 months) were similar in both g roups. Patients with silent ischemia were characterized by longer dura tion of exercise test (6.5 vs. 4.8 min, p < 0.01), larger extent of ma ximum ST depression during peak exercise (2.4 vs. 2.0 mm, p < 0.01) an d higher maximal double product at peak exercise (24,650 vs. 20,825, p < 0.01) compared to group 2. Long-term follow-up revealed similar rat es of mortality (3.6 vs. 4.8%, p = NS) and major cardiac events (19.3 vs. 21.7%, p = NS). However, patients with typical angina tended to ha ve more revascularization procedures (81 vs. 61%, p < 0.1). Thus, pati ents with silent ischemia have a better GXT capacity compared to patie nts with typical angina pectoris. Despite a similar severity of corona ry involvement, patients with typical angina pectoris tend to have mor e revascularization procedures, yet the long-term prognosis appears si milar.