THERAPEUTIC MEASURES AND IMPLICATIONS IN SILENT-MYOCARDIAL-ISCHEMIA

In principle, all forms of treatment applied in patients with symptomatic coronary heart disease may likewise be used in silent myocardial ischemia. Based on Bayes' theorem, therapeutic measures may only be applied in patients with a positive exercise ECG with a high likelihood of coronary heart disease, and/or with myocardial ischemia revealed by another, ECG-independent method, such as, for example, thallium-scintigraphy. As symptomatic improvement cannot be expected in patients with silent myocardial ischemia, therapeutic efficacy can only be documented by an improvement in prognosis. Results of controlled randomized trials are not available in silent myocardial ischemia; therapeutic recommendations can, therefore, only be based on analogous results obtained in patients with symptomatic forms of the disease. Apart from reduction of the known risk factors of coronary heart disease, aspirin may be given to all patients at risk. Among the antiischemic antianginal drugs, beta-receptor blocking agents without intrinsic-sympathomimetic activity may be expected to improve prognosis. In asymptomatic patients with left-stem stenosis and three-vessel disease with impaired left-ventricular function (also, in two-vessel disease with a stenotic dominant LAD) aorto-coronary bypass surgery may be considered in order to improve prognosis.