Conti C R, Geller N L, Knatterud G L, Forman S A, Pratt C M, Pepine C J, Sopko G
Division of Cardiology, University of Florida College of Medicine, Gainesville, USA.
Am J Cardiol. 1997 Apr 1;79(7):889-92. doi: 10.1016/s0002-9149(97)00009-x.
We hypothesized that among the patients enrolled in the Asymptomatic Cardiac Ischemia Pilot (ACIP) trial, those who reported angina either within the previous 6 weeks or experienced angina during ambulatory electrocardiographic (ECG) monitoring during activities of daily life or during stress testing would be more likely to experience an adverse cardiac event within a year than those who did not experience angina. Of the 558 patients enrolled in ACIP, 325 (58.2%) reported angina in the previous 6 weeks, 300 (53.8%) had stress-induced angina, and 63 (11.3%) reported angina during activities of daily life associated with ST-segment changes on the 48-hour ambulatory electrocardiogram. Some patients had > 1 of these angina symptoms and thus 8 angina status categories were identified. Adverse cardiac events were defined as death, nonfatal myocardial infarction (MI), or hospitalization for ischemic events, which included revascularization not specified by the ACIP protocol. One hundred and sixty-seven patients (29.9%) were asymptomatic (i.e., they never had angina) by our defined criteria. Three hundred ninety-one patients (70.1%) were symptomatic. Symptomatic patients had a higher incidence of death, MI, or hospitalization for ischemic events (15.3% symptomatic vs 7.8% asymptomatic, p = 0.016). History of angina within 6 weeks before randomization was predictive of death, MI, or hospitalization for ischemic event (p = 0.007). This finding was due to a large difference in the need for hospitalizations which would be expected to be driven by the presence of angina. By contrast, angina during ambulatory electrocardiogram or stress test was not predictive of an adverse cardiac event. The asymptomatic status of coronary disease patients who have objective documentation of ischemia is not uniformly defined and many different categories can be identified. In this population of patients with proven coronary artery disease and myocardial ischemia, a history of angina in the previous 6 weeks was a good predictor of an adverse event occurring in the next year.
我们假设，在参加无症状性心脏缺血试验（ACIP）的患者中，那些在过去6周内报告过心绞痛、或在日常生活活动或压力测试期间动态心电图（ECG）监测时发生心绞痛的患者，与未经历心绞痛的患者相比，在一年内发生不良心脏事件的可能性更高。在参加ACIP的558名患者中，325名（58.2%）在过去6周内报告过心绞痛，300名（53.8%）有压力诱发的心绞痛，63名（11.3%）在与48小时动态心电图ST段改变相关的日常生活活动期间报告过心绞痛。一些患者有不止一种这些心绞痛症状，因此确定了8种心绞痛状态类别。不良心脏事件定义为死亡、非致命性心肌梗死（MI）或因缺血事件住院，其中缺血事件包括ACIP方案未明确规定的血运重建。按照我们定义的标准，167名患者（29.9%）无症状（即他们从未有心绞痛）。391名患者（70.1%）有症状。有症状的患者发生死亡、MI或因缺血事件住院的发生率更高（有症状者为15.3%，无症状者为7.8%，p = 0.016）。随机分组前6周内心绞痛病史可预测死亡、MI或因缺血事件住院（p = 0.007）。这一发现是由于住院需求存在很大差异，预计这是由心绞痛的存在所驱动的。相比之下，动态心电图或压力测试期间的心绞痛并不能预测不良心脏事件。有缺血客观记录的冠心病患者的无症状状态定义并不统一，可以确定许多不同类别。在这群已证实患有冠状动脉疾病和心肌缺血的患者中，过去6周内心绞痛病史是下一年发生不良事件的良好预测指标。
