Comparison of the prognostic values of ischemia during daily life and ischemia induced by treadmill exercise testing.

Although silent ischemia is common in patients with stable coronary artery disease (CAD), controversy surrounds the issue regarding the most appropriate method for detection. Routinely performed exercise tolerance testing provides important prognostic information. However, ambulatory electrocardiographic monitoring (AEM) has the distinct advantage of enabling evaluation of silent ischemia during daily life. Although numerous AEM studies have found a greater occurrence of silent ischemia than symptomatic ischemia in patients with stable angina pectoris, the independent prognostic value of AEM findings has not been definitively established. Several recent studies have addressed the question of whether AEM supplies additional information beyond that obtained from exercise testing. The results of these studies revealed that myocardial ischemia during daily life that is detected by AEM provides additional and independent prognostic information in patients with stable CAD who have evidence of ischemia during exercise testing.