Silent cardiac ischemia

Abstract

Between the extremes of those who have no coronary disease and those limited by it are those with documented ischemia but no symptoms. Treating these patients in the "murky middle" generates some important questions. Should we treat patients with no symptoms solely on the basis of test abnormalities? Can we make the asymptomatic person better? What interventions would we use to treat such a disorder? How do we justify the risk, inconvenience, and cost of these interventions? How do we measure the efficacy of our intervention? Treating the asymptomatic person can only be justified if we prevent future events through our intervention. The management of silent ischemia can serve as a model for handling other preventative measures. The following article describes the issues around silent cardiac ischemia and some of the insights obtained in the Asymptomatic Cardiac Ischemia Pilot (ACIP) Study.

Silent Myocardial Ischemia

“…112 Unfortunately this study was not powered to detect a difference in mortality between the medically treated groups; furthermore, medical therapy was only adjusted twice during the follow-up and maximal therapy was not achieved. 113 The authors concluded that revascularization yields superior outcomes compared to angina-guided or ischemia-guided medical therapy but that larger scale multicenter clinical trial is needed to assess the medical therapeutic approaches.…”

Effects of anti-ischaemic drug therapy in silent myocardial ischaemia type I: the Swiss Interventional Study on Silent Ischaemia type I (SWISSI I): a randomized, controlled pilot study

“…[1][2][3] Silent ischaemia may occur in totally asymptomatic patients without (type I) or with (type II) a history of an ischaemic cardiac event and coexists with symptomatic episodes in many patients (type III). [1][2][3] In the absence of coronary angiography, most investigations on silent ischaemia relied upon documentation of asymptomatic ST-segment depression on Holter-ECG recordings or during stress testing for diagnostic purposes. However, both test methods have a low sensitivity and a rather high prevalence of false-positive results in clinically healthy men.…”

Effects of Percutaneous Coronary Interventions in Silent Ischemia After Myocardial Infarction

“…6 In patients with a recent MI, the Asymptomatic Cardiac Ischemia Pilot study documented a short-term benefit of anti-ischemic drug therapy and PCI in patients with silent and symptomatic ischemic episodes. [8][9][10][11] However, long-term outcome data in asymptomatic patients is lacking and it is not known whether PCI in addition to secondary preventive measures is superior to anti-ischemic drug therapy in these patients. Therefore, the Swiss Interventional Study on Silent Ischemia Type II (SWISSI II) was started 15 years ago with the aim of comparing the effects of PCI with drug therapy.…”