We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

Detection and Significance of Myocardial Ischemia in Stable Patients After Recovery From an Acute Coronary Event

Arthur J. Moss, MD; Robert E. Goldstein, MD; W. Jackson Hall, PhD; J. Thomas Bigger Jr, MD; Joseph L. Fleiss, PhD; Henry Greenberg, MD; Monty Bodenheimer, MD; Ronald J. Krone, MD; Frank I. Marcus, MD; Frans J. Th. Wackers, MD; Jesaia Benhorin, MD; Mary W. Brown, RN, MS; Robert Case, MD; James Coromilas, MD; Edward M. Dwyer Jr, MD; John A. Gillespie, MD; John J. Gregory, MD; Robert Kleiger, MD; Edgar Lichstein, MD; John O. Parker, MD; Richard F. Raubertas, PhD; Shlomo Stern, MD; Dan Tzivoni, MD; Lucy Van Voorhees, MD; G. Krasicky; R. Shah; J. Walroth; A. Greengart; M. Moriel; T. Challis; D. Blood; L. Rolnitzky; G. DePuey; L. Kuller; C. Odoroff; R. Schwartz; R. Annechiarico; M. Andrews; P. Severski; G. Ma; J. Edwards; K. Fischer; K. Freedland; L. Cobb; J. Korsten; W. Williams; S. Algeo; P. Chandysson
JAMA. 1993;269(18):2379-2385. doi:10.1001/jama.1993.03500180071037.
Text Size: A A A
Published online


Objective.  —To determine the clinical significance of silent and symptomatic myocardial ischemia detected by noninvasive testing in stable postcoronary patients.

Design.  —Cohort study with a mean 23-month follow-up.

Setting.  —Ambulatory outpatients after recent hospitalization for an acute coronary event.

Patients.  —Nine hundred thirty-six patients (76% male; mean age, 58 years) who were clinically stable 1 to 6 months after hospitalization for acute myocardial infarction or unstable angina.

Interventions.  —Noninvasive testing involved rest, ambulatory, and exercise electrocardiograms and stress thallium-201 scintigraphy.

Main Outcome Measures.  —Cox regression analysis was used to evaluate the risk (hazard ratio) of first recurrent primary events (cardiac death, nonfatal infarction, or unstable angina) or restricted events (cardiac death or nonfatal infarction) associated with ischemic noninvasive test results.

Results.  —ST segment depression on the rest electrocardiogram was the only noninvasive test variable that identified a significantly increased risk (P=.05) for first recurrent primary events (hazard ratio; 95% confidence limits): rest electrocardiogram ST depression (1.5; 1.00,2.25); ambulatory electrocardiogram ST depression (0.86; 0.49,1.51); exercise electrocardiogram ST depression (1.13; 0.82,1.56); and stress thallium-201 reversible defects (1.3; 0.96,1.74). Test results were similar for first recurrent restricted events, and in patients with and without angina. Significantly increased risk (P<.05) was noted when exercise-induced ST depression occurred in patients who also had reduced exercise duration (hazard ratio, 3.4) or when reversible thallium-201 defects occurred in patients who also had increased lung uptake (hazard ratio, 2.8). Each high-risk subset made up less than 3% of the population and contained less than 6% of patients with first primary events.

Conclusion.  —Detection of silent or symptomatic myocardial ischemia by noninvasive testing in stable patients 1 to 6 months after an acute coronary event is not useful in identifying patients at increased risk for subsequent coronary events.(JAMA. 1993;269:2379-2385)


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.