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Transient Myocardial Ischemia During Holter Registration Before and After Coronary Angioplasty

Department of Cardiology, University of Göteborg, Sahlgrenska Hospital, Göteborg, Sweden

Miguel Sánez

Department of Cardiology, University of Göteborg, Sahlgrenska Hospital, Göteborg, Sweden

HÅkan Emanuelsson

Department of Cardiology, University of Göteborg, Sahlgrenska Hospital, Göteborg, Sweden

Purpose: Revascularizing procedures like percutaneous transluminal coro nary angioplasty (PTCA) aim at reducing the incidence and severity of myocardial ischemia. To evaluate this, continuous Holter ST analysis is a possible method.

Design: 41 patients (35 men, 6 women) with stable angina pectoris had continuous twenty-four-hour two-channel Holter registration (V₅/aVF -analogous leads) recorded before and after PTCA. Transient myocardial ischemia (TM) was defined as 0.1 mV ST depression or more 80 msec after the J point for one minute or more.

Findings: PTCA was successful for 37 patients (90%). Eleven of these had a total of 53 episodes of TM, 36 (68%) before and 17 (32%) after PTCA (p<0.05). Fifteen episodes (28%) were symptomatic, and 38 (72%) were asymptomatic. Six patients had TM after successful PTCA, 5 of whom had one-vessel disease and a clinically uncomplicated course. One patient had multivessel disease, with only one vessel dilated. Follow-up angiograms for 9 of the 11 patients with TM revealed 5 restenoses. There was no significant correlation between TM after PTCA and subsequent restenosis (p>0.05).

Implications: TM is common in patients with stable angina pectoris. The incidence significantly decreases after successful PTCA, but TM is seen also with a clinically uncomplicated course. In multivessel disease this is consistent with incomplete revascularization, whereas in single-vessel disease the most likely cause is intermittent spasm or thrombosis. TM after successful PTCA does not seem to be a predictor of restenosis.

Angiology, Vol. 42, No. 6, 429-440 (1991)
DOI: 10.1177/000331979104200601


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