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Abstract
To assess the long-term prognostic significance of myocardial ischemia, as measured
by ambulatory electrocardiographic monitoring, in patients with occlusive peripheral
arterial disease, 176 eligible patients scheduled for elective peripheral arterial
surgery at Brigham and Women's Hospital were prospectively studied. All patients were
monitored preoperatively without alterations to baseline medications. Prospective
follow-up was obtained during routine medical care as provided by blinded, independent
physicians and by subsequent telephone contact with the patients. Thirty-two patients
(18%) had a total of 75 episodes of myocardial ischemia, 73 (97%) of which were asymptomatic.
During a mean follow-up period of 615 days, there were 9 cardiac deaths, 1 occurring
in-hospital after peripheral vascular surgery, and 13 nonfatal myocardial infarctions,
4 occurring in-hospital after peripheral vascular surgery. Cardiac events occurred
in 12 of 32 patients with ischemia (38%), including 6 cardiac deaths, and in 10 of
144 patients without ischemia (7%), including 3 cardiac deaths (risk ratio 5.4, 95%
confidence interval 2.6 to 11.4). The sensitivity of ischemia was 55%, the specificity
was 87%, the positive predictive value was 38%, and the negative predictive value
was 93%. In a multivariate Cox proportional-hazards model controlling for age, gender,
coronary risk factors, history of angina, myocardial infarction, coronary artery disease
and antianginal medications, the presence of ischemia was the only independent predictor
of outcome. In patients with peripheral arterial disease, who often are unable to
perform adequate exercise testing, ambulatory monitoring for myocardial ischemia is
a significant independent predictor of 1- to 2-year prognosis.
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Article Info
Publication History
Accepted:
July 23,
1990
Received:
May 29,
1990
Footnotes
☆This study was supported in part by the W.K. Kellogg Foundation, Battle Creek, Michigan, Program for Training in Research in Clinical Effectiveness, the American Heart Association, Massachusetts affiliate, Needham, Massachusetts, and by the National Institutes of Health, Bethesda, Maryland (Grant RO 1 HL 35295).
Identification
Copyright
© 1990 Published by Elsevier Inc.
