Silent ischemia in patients with previous myocardial infarct. Correlation of Holter and coronarography

OBJECTIVE: Our objective was to determine the presence of silent myocardial ischemia and the degree of coronary obstructions. DESIGN: Successively patients with myocardial infarction. SETTING: Patients admitted to the coronary intensive care, later followed in a specialised out-patients consultation. PATIENTS: 62 patients with previous myocardial infarction. INTERVENTIONS: All the patients were submitted to Holter-monitoring and coronary angiography. RESULTS: Silent ischemia was present in 14 (22,6%) of the patients. Seven of these (50%) had 3 vessels disease, 2 (14,3%) had 2 vessels disease, and 5 (35,7%) had 1 vessel disease. Twelve of the patients (86%) had occlusive lesions (greater than 90%), localised in 11 (79%) in the third proximal segment of the artery. CONCLUSIONS: Our results showed that the presence of silent myocardial ischemia was predominantly associated with 3 vessels disease, and with lesions of more than 90% of occlusion, localised in the 1/3 proximal of the vessel. Patients with previous myocardial infarction and silent ischemia may belong to a subgroup with surgical indication. And so, Holter studies in these patients should be followed by angiographic studies for localization of the obstructive lesions.