Silent ischaemia--to treat or not to treat?

The authors summarise published data concerning silent myocardial ischaemia: they review the studies showing the poor prognosis of this type of myocardial ischaemia but pose the question of whether this is due to the severity of the lesions causing the ischaemia or to the ischaemia itself. To answer this question, it would be necessary to set up a therapeutic trial showing that treatment preventing the electrocardiographic changes of silent ischaemia is associated with an improved prognosis. In the absence of solid evidence on this point, the authors present the case for and against treatment of silent ischaemia without drawing any formal conclusions.