European Heart Journal Advance Access originally published online on July 19, 2007
European Heart Journal 2007 28(17):2110-2117; doi:10.1093/eurheartj/ehm273
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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
1 Kantonsspital, Luzern, Switzerland
2 University Hospital, Bern, Switzerland
3 University Hospital, CH-4031 Basel, Switzerland
4 Klinik Im Park, Zurich, Switzerland
5 Rhätisches Kantonsspital, Chur, Switzerland
Received 22 March 2007; revised 1 June 2007; accepted 7 June 2007; online publish-ahead-of-print 19 July 2007.
* Corresponding author. Tel: +41 265 52 14; fax: +41 265 45 98. E-mail address: pfisterer{at}email.ch
See page 2053 for the editorial comment on this article (doi:10.1093/eurheartj/ehm325)
Aims: 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.
Methods and 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).
Conclusion: 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.
Key Words: Silent ischaemia • Coronary artery disease • Drug therapy • Risk factor intervention
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