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Electrocardiographic manifestations and in-hospital prognosis of transient acute myocardial ischemia at rest

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      Abstract

      From January 1970 to June 1985, transient electrocardiographic changes at rest were documented in 652 patients admitted to our coronary care unit. Patients were stratified according to the type of electrocardiographic alteration at rest: 295 had ST-segment elevation (group 1), 106, T-wave changes (group 2) and 251 ST-segment depression (group 3). Patients in group 3, compared with groups 1 and 2, were more likely to have symptoms of coronary artery disease dating back many years (p < 0.01 and p < 0.01, respectively), a previous myocardial Infarction (p < 0.05 and difference not significant), a positive exercise test (p < 0.01 and p < 0.01), translent ST-T changes occurring in a higher number of electrocardlographic leads (p < 0.01 and p < 0.01), multivessel disease (p < 0.001 and p < 0.01) and poor ventricular function (p < 0.01 and p < 0.05). Despite these differences, the occurrence of acute myocardial infarction and cardiac death during hospitalization was much more frequent in group 1 compared with groups 2 (p < 0.02) and 3 (p < 0.05). However, death occurred in those patients who had poor ventricular function and severe atherosclerosis. A greater susceptibility of group 1 patients to severe vasoconstriction documented by the ergonovine test and by the occurrence of spontaneous spasm seems to account for different in-hospital outcome.
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