Treatment of asymptomatic myocardial ischemia

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.