Yeung A C, Barry J, Orav J, Bonassin E, Raby K E, Selwyn A P
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115.
Circulation. 1991 May;83(5):1598-604. doi: 10.1161/01.cir.83.5.1598.
Ischemia on ambulatory electrocardiographic monitoring has been shown to adversely affect short-term prognoses in patients with unstable angina, after myocardial infarction, and with chronic stable angina.
In this long-term study, we followed 138 patients (mean age, 59 +/- 9 years) with chronic stable angina and positive exercise tests for cardiac events (e.g. death, myocardial infarction, percutaneous transluminal coronary angioplasty, or coronary artery bypass graft surgery). In 105 patients, ambulatory electrocardiographic monitoring was performed after all antianginal medication was withheld for 48 hours. In 26 patients, the diagnostic tests were repeated while on their usual medication. In addition to the 105 patients, 33 patients had their monitoring performed only while on their usual medication. During 37 +/- 17 months of follow-up, there were nine deaths, nine myocardial infarctions, and 35 revascularization procedures. In patients monitored off medication, Cox survival analysis showed that the occurrence of ischemia on electrocardiographic monitoring was the most significant predictor of death and myocardial infarction in the subsequent 2 years (p = 0.02) and all adverse events for 5 years (p = 0.009). Patients who were monitored on medication and did not have ischemia (n = 18) appeared to have more adverse events than patients who had no ischemia while being monitored off medication (n = 43).
Asymptomatic ischemia on ambulatory electrocardiographic monitoring in patients with stable angina predicts death and myocardial infarction for 2 years and all adverse events for 5 years. Monitoring performed while on medication may show no ischemia; however, this may not indicate low risk of future coronary events.
动态心电图监测显示的心肌缺血已被证明会对不稳定型心绞痛、心肌梗死后以及慢性稳定型心绞痛患者的短期预后产生不利影响。
在这项长期研究中，我们对138例（平均年龄59±9岁）慢性稳定型心绞痛且运动试验阳性的患者进行随访，观察心脏事件（如死亡、心肌梗死、经皮冠状动脉腔内血管成形术或冠状动脉旁路移植术）。105例患者在停用所有抗心绞痛药物48小时后进行动态心电图监测。26例患者在服用常规药物时重复进行诊断测试。除这105例患者外，33例患者仅在服用常规药物时进行监测。在37±17个月的随访期间，有9例死亡、9例心肌梗死和35例血运重建手术。在停药监测的患者中，Cox生存分析显示，心电图监测出现缺血是随后2年死亡和心肌梗死（p = 0.02）以及5年所有不良事件（p = 0.009）的最显著预测因素。服用药物进行监测且无缺血的患者（n = 18）似乎比停药监测时无缺血的患者（n = 43）有更多不良事件。
稳定型心绞痛患者动态心电图监测中的无症状缺血可预测2年的死亡和心肌梗死以及5年的所有不良事件。服用药物时进行的监测可能显示无缺血；然而，这可能并不表明未来发生冠状动脉事件的风险较低。
