PROGNOSIS OF SILENT ISCHEMIA IN ACUTE CORONARY SYNDROMES

The acute coronary syndromes are believed to result from rupture of th e fibrous cap of an atherosclerotic plaque in a coronary artery with s ubsequent intraluminal thrombosis. The thrombosis is the result of pla telet activation and aggregation; it may cause complete occlusion of t he vessel lumen, resulting in myocardial infarction, or cause intermit tent or partial occlusion of the vessel lumen, resulting in unstable a ngina [1]. Treatment of acute coronary syndromes is aimed at the timel y reduction of coronary ischemia and the prevention of myocardial necr osis. Over the past 13 years, studies have shown that silent myocardia l ischemia is common in patients with stable and unstable angina [2-5] . Silent ischemia has been correlated with transient abnormalities in myocardial perfusion and function [6,7]. In this review we shall summa rize salient studies of the value of detection of silent ischemia in p redicting prognosis in patients with the acute coronary syndromes; uns table angina and myocardial infarction.