Prognostic significance of ischemic episodes in patients with previous myocardial infarction

Dan Tzivoni*, Alex Gavish, Dan Zin, Shmuel Gottlieb, Mady Moriel, Andre Keren, Shmuel Banai, Shlomo Stern

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


This study assessed the prognostic significance of ischemic changes during daily activity as recorded by ambulatory electrocardiographic monitoring in a group of 224 low-risk postinfarction patients. Of the 224 patients studied, 74 (33%) had transient ischemic episodes on Holter monitoring. During the 28 months of follow-up the frequency of cardiac events (cardiac death, reinfarction, hospitalization for unstable angina, balloon angioplasty or coronary bypass surgery) was 51% among those with ischemic episodes on Holter monitoring, compared with 12% in those without such changes (p < 0.0001). The 74 patients with positive results in their exercise tests and Holter monitoring had a 51% event rate, compared with 20% among the 44 patients with a positive exercise test result but negative Holter results (p < 0.001). The event rate in those without ischemic changes either on the exercise test or on Holter was only 8.5%. Among patients with good (>40%) or reduced (<40%) left ventricular ejection fraction, those with transient ST depression on Holter had a significantly higher cardiac event rate compared with those without it. A similar event rate was found in patients with only silent, only symptomatic and with silent and symptomatic ischemic episodes.

Original languageEnglish
Pages (from-to)661-664
Number of pages4
JournalAmerican Journal of Cardiology
Issue number10 PART 1
StatePublished - 1 Oct 1988
Externally publishedYes


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