Effects of anti-ischaemic drug therapy in silent myocardial ischaemia type I: the Swiss Interventional Study on Silent Ischaemia type I (SWISSI I): a randomized, controlled pilot study.
OBJECTIVE
To determine the effect of anti-ischaemic drug therapy on long-term outcomes of asymptomatic patients without coronary artery disease (CAD) history but silent exercise ST-depression.


RESULTS
In a randomized multicentre trial, 263 of 522 asymptomatic subjects without CAD but at least one CAD risk factor in whom silent ischaemia by exercise ECG was confirmed by stress imaging were asked to participate. The 54 (21%) consenting patients were randomized to anti-anginal drug therapy in addition to risk factor control (MED, n = 26) or risk factor control-only (RFC, n = 28). They were followed yearly for 11.2 +/- 2.2 years. During 483 patient-years, cardiac death, non-fatal myocardial infarction, or acute coronary syndrome requiring hospitalization or revascularization occurred in 3 (12%) of MED vs. 17 (61%) of RFC patients (P < 0.001). In addition, MED patients had consistently lower rates of exercise-induced ischaemia during follow-up, and left ventricular ejection fraction remained unchanged (-0.7%, P = 0.597) in contrast to RFC patients in whom it decreased over time (-6.0%, P = 0.006).


CONCLUSIONS
Anti-ischaemic drug therapy and aspirin seem to reduce cardiac events in subjects with asymptomatic ischaemia type I. In such patients, exercise-induced ST-segment depression should be verified by stress imaging; if silent ischaemia is documented, anti-ischaemic drug therapy and aspirin should be considered.
Erne
Paul
P
Kantonsspital, Luzern, Switzerland.
Schoenenberger
Andreas W
AW
Zuber
Michel
M
Burckhardt
Dieter
D
Kiowski
Wolfgang
W
Dubach
Paul
P
Resink
Therese
T
Pfisterer
Matthias
M
D054058:Acute Coronary Syndrome / Q000517:prevention & control; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D017311:Amlodipine / Q000627:therapeutic use*; D017298:Bisoprolol / Q000627:therapeutic use*; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D006801:Humans; D008875:Middle Aged; D008981:Molsidomine / Q000627:therapeutic use*; D009203:Myocardial Infarction / Q000517:prevention & control; D017202:Myocardial Ischemia / Q000188:drug therapy*; D010349:Patient Compliance; D010865:Pilot Projects; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use*; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy
D000319:Adrenergic beta-Antagonists; D014665:Vasodilator Agents; D017311:Amlodipine; D008981:Molsidomine; D017298:Bisoprolol