Samina Saeed, Tariq Waseem, Hamid Khalil.
Frequency of silent myocardial ischemia in patients with established coronary artery disease.
J Fatima Jinnah Med Coll Lahore Jan ;1(3-4):68-9.

Objective: To determine the incidence of silent ischemia in patients with established coronary artery disease Setting: Mayo Hospital, Lahore. Participants: Fifty consecutive patients with documented coronary artery disease either having a previous history of thrombolysis or coronary revascularization and a positive exercise tolerance test (ETT) were analyzed to note the occurrence of silent myocardial ischemia. There were 42 men and 8 women with an overall average age of 52 years. Average ages of male and female patients were 50 and 58 years respectively. Majority of patients (31) underwent ETT as a post (>6 weeks) myocardial infarction evaluation. Eleven patients (11) were tested for 1 years post CABG assessment and 8 had a post (1 year) angioplasty evaluation. Interventions: All patients were randomly subjected to “Exercise Tolerance Test” (ETT). Number of patients having silent ischemia vs. angina was calculated. Results: Out of 50 patients, 28 (56%) showed silent ischemia and 22 patients (44%) showed symptomatic ischemia (p<0.05). Nine out of 11(p<0.005) post CABG, 15(48.4%) out of 31(p>0.3) post MI and 4(50%) out of 8 post angioplasty patients (p>0.3) showed silent ischemia. Conclusion: Angina alone should not be considered as an indicator of ongoing ischemia in patients with established coronary artery disease as silent myocardial ischemia occurs in more than half of these patients. All such patients should undergo suitable evaluation for early diagnosis and appropriate intervention or modification of medical treatment considered to avoid any future adverse outcome.

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