Silent ischemia: to treat or not

As worded, the question "Should silent ischemia be treated?" needs to be examined carefully, assuming that silent ischemia is even the correct topic of the question. The way the question is phrased influences the answer. The more the question's permutations are examined, the clearer it becomes that the problem is one of definition. Our conceptualization of the ischemic process is still incomplete, and the question of whether to treat silent ischemia remains. Ultimately, the decision will depend on demonstrable benefit for prognosis. Every acute ischemic syndrome is indicative of poor prognosis, independent of other factors associated with adverse outcome and of the method of measurement. The true determinant of the need to treat is the total ischemic pattern, and how silent ischemia and angina fit within that context is not yet known.