DETECTION OF AMBULATORY ISCHEMIA IS NOT OF PRACTICAL CLINICAL-VALUE IN THE ROUTINE MANAGEMENT OF PATIENTS WITH STABLE ANGINA - A LONG-TERM FOLLOW-UP-STUDY

It has been reported that medically, treated patients with stable angina and positive exercise test for ischaemia have an adverse 1-2 year outlook if they are shown also to have transient, and predominantly silent, ischaemic episodes detected by ambulatory ST segment monitoring during their daily activities. it has been suggested that this investigation could be used to identify patients more likely to benefit from early investigation and treatment. We assessed the long-term (up to 65 months) prognostic significance of transient ischaemic episodes during daily activities in 172 patients routinely attending cardiac outpatients with medically treated stable angina who had undergone exercise testing and 48 h of ambulatory ST segment monitoring between February 1988 and August 1989 for this purpose. A positive exercise test for ischaemia was not a prerequisite for inclusion. One hundred and four patients (60.5%) had a positive exercise test for ischaemia and 72 (42%) had transient ischaemia during daily activities (63 had both tests positive). Over a median 50-month follow-up period 54 patients suffered at least one cardiac event (primary event: cardiac death n=7; non-fatal myocardial infarction n=11, unstable angina n=18; elective CABG/PTCA n=18). Two further patients suffered non-cardiac death. Cardiac events, either objective (cardiac death or non-fatal myocardial infarction) or subjective (unstable angina or revascularisation) were no more likely to occur in those with transient ischaemia during daily life when compared with those without, at follow-up rimes up to 65 months. The detection of transient ischaemia during daily life is of limited practical clinical value in the management of 'low risk' medically treated patients with stable angina, and does not appear to help identify subgroups at increased risk of an adverse outcome at follow-up to more than 5 years.