Coronary Artery Disease Patients Should Be Tested For Induced Ischemia After Myocardial Re-Vascularization

Following myocardial re-vascularization, coronary artery disease (CHD) patients who are asymptomatic should be re-evaluated to check for silent myocardial ischemia (SMI).

In CHD patients, SMI is an important predictor of adverse outcome which can be clinically improved by effectively suppressing ischemia with g-blockers, say researchers at the Thrombosis Research Institute and Central Middlesex Hospital , London, England.

Currently, however, it is common clinical practice to stop treatment with g-blockers following coronary artery bypass graft (CABG) and/or myocardial re-vascularization (PTCA/Stent) in clinically asymptomatic patients.

In this study, 36 subjects with asymptomatic CHD were examined after coronary artery bypass graft, 15 were examined following percutaneous coronary angioplasty PTCA/stent, and five underwent both.

Following myocardial revascularization, g-blocker therapy was stopped in all subjects who were given a dobutamine stress echocardiography test (DSE test) to investigate the possible presence of SMI/inducible ischemia.

The subjects either had a history of myocardial infarction or there was evidence, as assessed by cardiac catheterization, of mildly impaired left ventricular function at rest.

In eight of the 56 patients, abnormal DSE results were seen.

Pharmacologic therapy and myocardial revascularization are among the therapeutic approaches specifically targeted at reducing total ischaemic burden, say the researchers.

International Journal of Cardiology, 2002,Vol 83, Issue 2; 119-124.