Abstract
Silent ischemia has been characterized by ST-segment shifts in the absence of angina and has been shown to be associated with an adverse prognosis in some patient subgroups.
1–4 The detection of silent ischemia by ambulatory monitoring has increased in popularity.
4–6 Some studies of silent ischemia have enrolled untreated patients with known coronary artery disease (CAD) and positive exercise stress tests. This bias in the pretest likelihood of the presence and severity of disease is likely to limit the clinical application of such studies. Further-more, withdrawing medications in order to assess risk would seem inappropriate in everyday clinical practice. This study was designed to look at the ambulatory electrocardiographic monitoring detection of “ischemic” ST-segment changes during the pericatheterization period in 50 patients admitted for cardiac catheterization. Each patient had cardiovascular symptomatology severe enough to warrant cardiac catheterization, but the pre-test likelihood of the detection of ischemia had not been biased by prior diagnostic studies or a change in treatment. Thus, the study was specifically designed to relate to patients in a practical clinical setting.
