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Should silent ischemia be treated in asymptomatic individuals?
1Department of Medicine, State University of New York Health Sciences Center, Stony Brook 11794.
Circulation
|September 1, 1990
Summary
Silent myocardial ischemia affects millions of asymptomatic men. Early detection via exercise tests and risk factor assessment is crucial for identifying high-risk individuals with coronary artery disease.
Area of Science:
- Cardiology
- Preventive Medicine
Background:
- Coronary artery disease (CAD) affects millions of asymptomatic men, often detected incidentally.
- High-risk subgroups with multiple risk factors or family history warrant rigorous screening for silent myocardial ischemia.
Purpose of the Study:
- To review screening protocols and prognostic implications for asymptomatic individuals with potential coronary artery disease.
- To discuss the role of diagnostic procedures and treatment efficacy in this population.
Main Methods:
- Exercise testing as the initial screening procedure.
- Radionuclide procedures for differentiating true-positive from false-positive exercise tests.
- Holter monitoring for documenting ischemic events in asymptomatic patients with known CAD.
Main Results:
- Asymptomatic patients with ischemic ST-segment depression on exercise tests represent a high-risk subgroup with significant future cardiac event morbidity and mortality.
- Extensive coronary artery disease identified through angiography correlates with the greatest risk.
- Beta-blockers, calcium channel blockers, and angioplasty show efficacy in reducing ischemic activity.
Conclusions:
- Objective measurements are essential for guiding treatment in asymptomatic individuals with silent myocardial ischemia.
- While nonsurgical therapies reduce ischemic activity, their impact on long-term prognosis remains unclear.
- Surgical therapy in asymptomatic patients with left main or triple-vessel disease may improve long-term survival.