Increased Incidence of Silent Ischemia After Acute Myocardial Infarction
- George J. Taylor, MD;
- Richard E. Katholi, MD;
- Kelly Womack, RN;
- H. Weston Moses, MD;
- W. T. Woods, PhD
Abstract
Objective. —To determine the incidence of angina pectoris during induced myocardial ischemia in patients who have had thrombolytic therapy for acute myocardial infarction in comparison with patients with angina pectoris.
Design. —During percutaneous transluminal coronary angioplasty, both study groups had coronary artery occlusion by the balloon dilatation catheter for 5 minutes.
Setting. —A tertiary, cardiology referral center.
Patients. —Twenty-five patients with angina pectoris who were undergoing angioplasty were compared with 30 patients having angioplasty 2 days after thrombolytic therapy for acute myocardial infarction.
Outcomes. —Development of angina pectoris during balloon occlusion of the coronary artery was the primary end point; the ischemic response and muscle viability were assessed using both surface and intracoronary electrocardiograms and pulmonary artery wedge pressure.
Results. —During balloon occlusion 16 (64%) of 25 patients in the angina pectoris group developed angina. In contrast, nine (30%) of 30 patients in the thrombolysis group had angina pectoris during balloon occlusion of the infarct artery (P<.01). The electrocardiographic response to ischemia and changes in pulmonary wedge pressure were similar in the two study groups.
Conclusion. —After thrombolytic therapy for myocardial infarction, silent ischemia may be the rule rather than the exception.
(JAMA. 1992;268:1448-1450)
Footnotes
-
Reprint requests to PO Box 19420, Springfield, IL 62794-9420 (Dr Taylor).
