Department of Geriatrics, University of Bern Hospital Inselspital Bern, Switzerland.
Eur J Intern Med. 2009 Oct;20(6):607-10. doi: 10.1016/j.ejim.2009.04.001. Epub 2009 May 8.
The incidence of coronary artery disease (CAD) in totally asymptomatic patients with myocardial ischemia during stress testing is unknown.
54 patients with asymptomatic myocardial ischemia participated in the Swiss Interventional Study on Silent Ischemia type I (SWISSI I). Asymptomatic myocardial ischemia was verified by bicycle ergometry and stress imaging (echocardiography or scintigraphy). Findings from coronary angiographies in the course of the study constituted the main outcome.
Of the 54 study participants, 29 patients (53.7%) underwent coronary angiography. CAD was found in 27 of 29 patients (93.1%). In those 27 patients with CAD, 9 patients (33.3%) suffered from single vessel disease, 9 patients (33.3%) from two vessel disease, and 9 patients (33.3%) from triple vessel disease. Two patients showed left main coronary artery stenosis.
This study shows a high incidence of relevant CAD among totally asymptomatic patients with myocardial ischemia during stress testing. Previously healthy subjects with exercise-induced ST-segment depression at check-up examinations, even if asymptomatic, should have further diagnostic evaluation.
在应激试验期间无症状心肌缺血的患者中，冠状动脉疾病（CAD）的发生率尚不清楚。
54 例无症状心肌缺血患者参与了瑞士无症状缺血 I 型介入研究（SWISSI I）。通过踏车运动和应激成像（超声心动图或闪烁扫描）验证无症状性心肌缺血。研究过程中的冠状动脉造影结果构成了主要结局。
54 例研究参与者中，29 例（53.7%）接受了冠状动脉造影。29 例患者中，27 例（93.1%）存在 CAD。在这 27 例 CAD 患者中，9 例（33.3%）为单支血管病变，9 例（33.3%）为两支血管病变，9 例（33.3%）为三支血管病变。2 例患者表现为左主干冠状动脉狭窄。
本研究表明，在应激试验期间无症状心肌缺血的患者中，CAD 的发生率较高。在体检时出现运动诱发 ST 段压低但无症状的健康人群，即使没有症状，也应该进行进一步的诊断评估。
