Silent myocardial ischaemia in patients with proved coronary artery disease: a comparison of diabetic and non-diabetic patients
C J Ditchburn, J A Hall, M de Belder, A Davies, W Kelly, R Bilous
Department of
Cardiology, Division of Cardiothoracic Medicine, South Cleveland
Hospital, Middlesbrough, UK
Correspondence to: Dr C J Ditchburn, c/o Cardiology Secretaries, South Cleveland Hospital, Marton Road, Middlesbrough, Cleveland TS4 3BW, UK cjditchburn{at}ntlworld.com
Submitted 21 May 2000;
Accepted 2 October 2000
OBJECTIVE
To determine whether
diabetic patients with coronary artery disease are more likely to
experience silent myocardial ischaemia than subjects without diabetes.
SUBJECTSPatients undergoing
coronary angiography at a regional cardiothoracic unit, identified as
having diabetes from the local district diabetic register/database.
DESIGNThe coronary angiograms and
exercise treadmill tests of 100 diabetic and 100 non-diabetic patients
who all had significant coronary artery disease and maximal effort
exercise tests were reviewed. Patients were individually matched for
age group, gender, severity of coronary artery disease, and indication
for treadmill test.
OUTCOME MEASURESSignificant
coronary artery disease was defined as a stenosis of greater than 50%
diameter in at least one of the major coronary artery segments.
Exercise tests were graded as positive if the electrocardiographic
(ECG) recording showed planar or downsloping ST segment depression of
1 mm in more than two leads at 80 ms post J-point or if there was a
blood pressure fall 10 mm Hg after an initial rise. A negative
exercise test was defined as one in which the subject experienced no
pain, had no ECG changes after maximal effort and had a normal blood
pressure response. Subjects who did not experience any form of typical
angina-type pain during a positive exercise test were defined as having
an episode of silent ischaemia. Patients with symptomatic ischaemia
were those who experienced typical angina-type pain with accompanying
ST segment changes. Patients with a negative exercise test were defined as having "undetermined ischaemia". This category included all those without ECG evidence of myocardial ischaemia during the exercise
test (with or without accompanying chest pain).
RESULTSIn the diabetic patients,
34% had ECG evidence of silent ischaemia on treadmill testing compared
with only 19% of the non-diabetic controls (p<0.02).
CONCLUSIONSThis study shows that
diabetic patients with proved coronary artery disease have a higher
risk of developing silent myocardial ischaemia during exercise than
non-diabetic patients.
Keywords: coronary heart disease; ischaemia; diabetes; prevalence
© 2001 by The Fellowship of Postgraduate Medicine
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