Surgical or medical intervention: which approach is more effective for patients with silent myocardial ischemia?

This study investigated if revascularization (RV) is more effective than medical treatment (MT) in patients with silent myocardial ischemia (SMI). They found that RV was more effective than MT at reducing the risk of death in these patients.

Coronary heart disease (CHD) is a major cause of death worldwide. Myocardial ischemia is a type of CHD. It is caused by reduced blood flow to the heart. As a result, less oxygen reaches the heart muscle. This can cause a heart attack. Reduced blood flow can be caused by blockages in the blood vessels. Revascularization (RV) is a surgical procedure used to remove blockages and restore blood flow.

Silent myocardial ischemia (SMI) is a condition where blood flow is reduced but patients do not have severe symptoms. For patients with SMI, medical treatment (MT) can be used instead of RV. MT involves using medication to manage SMI. MT can reduce blood pressure and prevent blockages becoming worse. There is some disagreement amongst doctors as to which approach (RV vs. MT), is better for SMI. It is unclear if RV or MT is more successful in patients with SMI.

This study included 1473 patients with SMI. Patients were undergoing either RV (48.1%) or MT (51.9%). RV included procedures such as coronary artery bypass graft (CABG; a type of surgery that improves blood flow to the heart) and percutaneous coronary intervention (PCI; a non-surgical procedure that uses a small tube to open up blood vessels in the heart). Patients underwent stress tests to measure the heart’s response before and after treatment.

Patients that underwent RV had a 37% lower risk of cardiac (heart-related) death. RV-treated patients had a 22% reduced risk of death from any cause. The risk of death after a heart attack was 50% lower in patients that underwent RV. CABG and PCI had similar reductions in death risk. MT was associated with a 100% increased risk of cardiac death.

The authors concluded that RV was more effective than MT at reducing the risk of death.

Following RV many patients were prescribed medication to prevent further blockages. This may have had a significant effect on the risk of cardiac death. RV without medication may not be as effective.

If you have any questions regarding treatment for CHD, please discuss this with your doctor.