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SHOULD SILENT ISCHEMIA BE SUPPRESSED?

Should electrocardiographic ischemia be treated even if it causes no symptoms? As a first step toward answering this question, the Asymptomatic Cardiac Ischemia Pilot (ACIP) study evaluated 618 patients who had coronary artery disease suitable for revascularization, ischemia on stress testing, and asymptomatic ischemia on ambulatory ECG monitoring.

The patients were randomized to one of three treatment strategies: medical therapy aimed at relieving angina, therapy to relieve both angina and ischemia on ambulatory monitoring, or revascularization by angioplasty or bypass surgery.

At 12 weeks, 39 percent, 41 percent, and 55 percent of these groups, respectively, were free of ischemia on ambulatory monitoring. Patients whose treatment was guided by ambulatory monitoring received higher average doses of beta- and calcium-blockers than those whose therapy was guided by symptoms only. Complication rates were similar in the three groups, but this pilot study lacked sufficient power to detect differences in clinical outcome.

Comment: This study shows that treatment guided by symptoms alone abolished ischemia as effectively as therapy to eliminate silent ECG-detected ischemia, even though the more aggressive approach used more medications. It will take a long-term, large-scale randomized trial to determine whether treating silent ischemia can prevent coronary events and deaths.

— TH Lee

Published in Journal Watch General Medicine July 15, 1994

Citation(s):

Knatterud GL et al. Effects of treatment strategies to suppress ischemia in patients with coronary artery disease: 12-week results of the Asymptomatic Cardiac Ischemia Pilot (ACIP) study. J Am Coll Cardiol 1994 Jul 24 11-20.

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