Threshold, incidence, and predictors of prognostically high-risk silent ischemia in asymptomatic patients without prior diagnosis of coronary artery disease

Michael J. Zellweger MD, Rory Hachamovitch MD, MSc, Xingping Kang MD, Sean W. Hayes MD, John D. Friedman MD, Guido Germano PhD, Daniel S. Berman MD
Original Article
Volume 16, Issue 2 / April , 2009

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Abstract

Background

Little is known about incidence, threshold, and predictors of prognostically relevant silent ischemia (SI). The aim was to study these three aspects of silent coronary artery disease (CAD).

Methods

In total, 3,664 consecutive asymptomatic patients without prior diagnosis of CAD undergoing myocardial perfusion SPECT (MPS) were evaluated and followed-up ≥1 year for Events (HE): cardiac death or myocardial infarction. MPS was interpreted using a 20 segment model to define summed stress, rest, and difference scores (the extent of % myocardium ischemic was derived). Prognostic high-risk ischemia was defined as ischemia consistent with a HE rate ≥3%.

Results

Overall, ≥7.5% myocardium ischemic was consistent with high risk. Twenty-one and six percent of patients had ischemia and high-risk ischemia, respectively. Patients with high-risk ischemia had a worse prognosis than patients with less SI, HE rate of 3.1 and 0.4%, respectively, (P = .0001). Sex, age, diabetes, hypertension, abnormal resting ECG, angina, peak heart rate, blood pressure during treadmill testing, ST-depression, and Duke treadmill score were independent predictors of relevant SI.

Conclusions

In total, ≥7.5% myocardium ischemic revealed to be consistent with high risk. Six percent of patients had evidence of high-risk SI. Diagnostic scores are provided to most likely identify patients with high-risk SI.

Keywords

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