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Alistair.Lindsay@btinternet.com
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INTERVENTIONAL CARDIOLOGY
Even after surviving myocardial infarction (MI), subclinical or "silent" ischaemia is common. The effect of percutaneous coronary intervention (PCI) on the long-term prognosis of these patients is not known.
The SWISSI II (Swiss Interventional Study on Silent Ischaemia Type II) trial was an unblinded controlled trial that randomised patients with a recent MI to PCI aimed at full revascularisation (n = 96), or to intensive anti-ischaemic drug treatment (n = 105). All patients had silent myocardial ischaemia verified by stress imaging, and one- or two-vessel coronary disease. The main outcome measure was survival free of major adverse cardiac events (cardiac events, non-fatal MI, and/or symptom-driven revascularisation).
The mean follow-up was 10.2 years; 27 major adverse cardiac events occurred in the PCI group and 67 in the anti-ischaemic drug treatment group (adjusted hazard ratio = 0.33; p<0.001). Patients in the PCI group also had lower rates of ischaemia (11.6% vs 28.9%;
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