Background. Asymptomatic myocardial ischemia is commonly observed in patien
ts with coronary artery disease, Numerous studies have shown that patients
with asymptomatic ischemia are at higher risk for adverse outcome than thos
e without ischemia. Several recent studies have investigated the therapeuti
c options available in the management of patients with asymptomatic myocard
ial ischemia.
Methods. Recently published randomized controlled trials investigating the
treatment of asymptomatic myocardial ischemia were reviewed.
Results. The controlled trials suggest that (1) asymptomatic ischemia can b
e suppressed to various degrees using pharmacologic therapy or revasculariz
ation, (2) beta-blockers are in general superior to calcium channel blocker
s or nitrates in relieving asymptomatic ischemia, and (3) revascularization
is superior to pharmacologic therapy.
Conclusions. A growing body of evidence suggests that in patients with coro
nary artery disease, treatment of asymptomatic ischemia may result in impro
ved outcome. However because of significant limitations in the published st
udies, additional studies with large sample sizes and broader inclusion cri
teria are needed.