HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text Free Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (6) Citing Articles via Google Scholar Google Scholar Articles by Nair, C. K. Articles by Hilleman, D. E. Search for Related Content PubMed PubMed Citation Articles by Nair, C. K. Articles by Hilleman, D. E.

Diagnostic and Prognostic Value of Holter-Detected ST-Segment Deviation in Unselected Patients With Chest Pain Referred for Coronary Angiography^*

A Long-term Follow-up Analysis

^* From the Division of Cardiology, Department of Medicine, Creighton University School of Medicine, Omaha, NE.

Correspondence to: Chandra K. Nair, MD, FCCP, Creighton University Cardiac Center, 3006 Webster St, Omaha, NE 68131

Objective: To evaluate the diagnostic and prognostic significance of ST-segment deviation detected by ambulatory Holter monitoring in unselected chest pain patients referred for coronary angiography.

Methods: Two hundred seventy-seven patients (71% were men) who underwent coronary angiography for evaluation of chest pain were studied with 24-h ambulatory Holter monitoring within 72 h of angiography. A lumen diameter reduction of 50% was considered coronary artery disease. The ST-segment deviation was defined as 1-mm deviation from the baseline lasting 1 min separated by a minimum of 1 min. The patients were followed up for 65 ± 21 months (mean ± SD) for occurrences of death, myocardial infarction, hospitalization for unstable angina, and need for revascularization.

Results: Of the 277 patients, 223 (80%) had coronary artery disease. The prevalence of coronary artery disease was not significantly different in patients with (43 of 48 patients; 90%) and without (180 of 229 patients; 79%) Holter-detected ST-segment deviation. The diagnostic accuracy of Holter-detected ST-segment deviation in predicting the presence of coronary artery disease was poor (33%), with a sensitivity of 19% and a specificity of 91%. The presence of Holter-detected ST-segment deviation was not predictive of future cardiac events or death.

Conclusion: The ST-segment changes detected on ambulatory Holter monitoring are of limited value in identifying coronary artery disease and predicting the future adverse cardiac events or death in unselected patients with chest pain.

Key Words: ambulatory ECG monitoring • coronary artery disease • diagnostic accuracy • ECG • Holter monitoring • ischemic heart disease • sensitivity • silent ischemia • specificity • ST segment

This article has been cited by other articles:

				P. F. Cohn, K. M. Fox, and C. Daly Silent Myocardial Ischemia Circulation, September 9, 2003; 108(10): 1263 - 1277. [Full Text] [PDF]

				C. Desouza, H. Salazar, B. Cheong, J. Murgo, and V. Fonseca Association of Hypoglycemia and Cardiac Ischemia: A study based on continuous monitoring Diabetes Care, May 1, 2003; 26(5): 1485 - 1489. [Abstract] [Full Text] [PDF]