David A. Silverstein, MD
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To the Editor: In his article on silent myocardial ischemia, Dr. Cohn (1) clearly describes the mechanisms, diagnosis, and prognosis of this condition. In his recommendations for screening and management, however, he ignores his conclusion that the benefits of treatment remain unproved. Although the benefits of treatment are unproved, the potential for doing harm is great, particularly in patients with type 1 (asymptomatic) ischemia.
Cohn recommends screening exercise tests for asymptomatic persons with two or more risk factors for coronary artery disease. For persons with positive test results that show less than 2 mm of ST depression, he recommends confirmation
Silverstein DA. Silent Myocardial Ischemia. Ann Intern Med. ;109:923–924. doi: 10.7326/0003-4819-109-11-923
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Published: Ann Intern Med. 1988;109(11):923-924.
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