Clinical trials in silent ischaemia: lessons from TIBET

The Total Ischaemic Burden European Trial (TIBET) affords the opportunity to investigate the prognostic value of both exercise testing and ambulatory monitoring on and off medical treatment; 682 patients were followed for two years. Patients with < 1 mm ST segment depression on exercise testing have very low risk indeed of an important end point in a two year period, and this effect is partially obscured by the presence of medical treatment. Ambulatory monitoring showed that the presence of silent ischaemia had little prognostic impact in this group of patients.