Effects of Percutaneous Coronary Interventions in Silent Ischemia After Myocardial Infarction

Abstract

clinicaltrials.gov Identifier: NCT00387231.

Percutaneous Coronary Intervention Plus Medical Therapy Reduces the Incidence of Acute Coronary Syndrome More Effectively Than Initial Medical Therapy Only Among Patients With Low-Risk Coronary Artery Disease

“…In the present study, however, the cumulative rate of cardiac events (e.g., ACS) was smaller in the PCIϩMT group than the initial MT group, although there was no significant difference on death. This finding is consistent with those of the SWISSI II study (4), which reported that PCIϩMT reduced the long-term risk of major cardiac events in patients with silent MI after MI. For the patients in the present study, who had 1-or 2-vessel disease, the cumulative rate of ACS during the 3.3-year follow-up was 5.0% in the PCIϩMT group and 11.7% in the initial MT group.…”

Reply

“…The results of our analysis suggest that, although a benefit exists in the entire cohort of patients, those studies with more liberal angiographic inclusion criteria were more likely to be positive than those with more strict criteria, and, therefore, we learned not only that late revascularization was associated with improved survival but also that patients with subtotal occlusion may benefit the most. These findings are consistent with the results of 2 individual studies, the ALKK (Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte) study (11) and the SWISSI II study (4), which enrolled patients late after AMI independent of IRA status and showed a survival benefit for late percutaneous coronary intervention. Furthermore, we are not sure that total and subtotal occlusions are 2 different disease processes as we believe that they are 2 presentations of the same process and that significant functional and clinical overlap exists between the 2 conditions.…”

Percutaneous Coronary Intervention for Chronic Stable Angina

“…This was a pilot study and emphasizes the importance of designing and implementing larger adequately powered trials. Similar results were found in the SWISSI II (Swiss Interventional Study on Silent Ischemia Type II) trial, a small trial of 201 patients with a prior MI and silent ischemia, which found a benefit for PCI in regard to recurrent events over a 10-year follow-up period (34). Thus, it may be that, among the large number of patients with stable CAD, those with silent ischemia may be a high-risk group that can benefit from PCI.…”