A new look at benefits of drug therapy in silent myocardial ischaemia

Abstract

Over 25 years ago we prepared a classification system for silent myocardial ischaemia that we hoped would make it easier for future researchers to study the pathophysiogical basis for the syndrome, establish prognosis, and determine appropriate management protocols.1 In our categorization, Cohn Type I refers to asymptomatic individuals without known coronary artery disease (CAD) and Cohn Types II and III to patients with known CAD. Those with prior myocardial infarctions (MIs) who are asymptomatic are Type II, and those with CAD and both silent and symptomatic ischaemic episodes are Type III.1 In the last decade a dedicated group of Swiss cardiologists led by Dr Mathias Pfister of the Basel University Hospital have conducted a long-term series of clinical studies involving patients with Types I and II silent ischaemia. By providing a ‘new look’ at the syndrome of silent ischaemia they have contributed important clinical data to aid in its management. They have now described the results of anti-ischaemia drug therapy in Type I patients (studied in their SWISS I trial);2 their SWISS II data dealing with Type 2 patients and also recently published3 will be commented on later in this editorial. Investigations into silent ischaemia have been centred on either its pathophysiology, prevalence, prognosis, or treatment, or the effect of treatment on prognosis.4 Although recent pain studies have not yet been able to pinpoint the … Corresponding author. Tel: +1 631 444 1061; fax: +1 631 444 1054. E-mail address: pcohn{at}notes.cc.sunysb.edu