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(Circulation. 1997;95:1992-1993.)
© 1997 American Heart Association, Inc.

Articles

Silent Myocardial Ischemia: Some Good News

Thomas Killip, MD

From the Albert Einstein College of Medicine and Beth Israel Medical Center, New York, NY.

Correspondence to Thomas Killip, MD, Beth Israel Medical Center, 16th St @ 1st Ave, New York, NY 10003. E-mail: tkillip@bethisraelny.org

Key Words: Editorials • revascularization • ischemia

	Introduction

 
In patients with coronary artery disease, silent myocardial ischemia is a troublesome problem for the clinician.¹ It is an iceberg: a small amount is readily visible, but much more remains hidden from view. In the absence of evidence-based guidelines for treatment, many questions arise, including how assiduously should it be sought and what should be done about it when found?

Estimated to occur in 4% to 5% of an asymptomatic male population in their fifth decade² but far more common in patients with angina pectoris, silent ischemia is most often recognized during exercise testing or fortuitously with ambulatory electrocardiography. A number of studies have now clearly demonstrated that patients with silent ischemia have increased risk for coronary events: sudden death or myocardial infarction.^{3 4 5 6} Reasoning that if silent ischemia is bad, then amelioration with revascularization must be good, investigators have reported nonrandomized observational data to support an aggressive therapeutic approach.^{7 8 9} These anecdotal reports cannot be evaluated, however, because careful studies comparing revascularization with state-of-the-art medical treatments have heretofore been lacking.

In the current issue of Circulation, Davies et al⁹ report on the Asymptomatic Cardiac Ischemia Pilot (ACIP) Study 2-year follow-up, a randomized trial designed to determine whether the prognosis of patients with silent ischemia is improved by aggressive treatment with anti-ischemic drugs or revascularization. Because concern has been expressed about the quality of many reported randomized clinical trials,¹⁰ it is worthwhile to review the ACIP study on the basis of the CONSORT (CONsolidated Standards Of Reporting Trials) statement, which provides . . . [Full Text of this Article]

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