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August 22/29, 2007

Percutaneous Coronary Interventions for Silent Ischemia After Myocardial Infarction—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2007;298(8):860-861. doi:10.1001/jama.298.8.860-b

In Reply: Drs Kalay and Ozdogru postulate that coronary lesion complexity and insufficient use of ACE inhibitors in patients may have influenced the results of the Swiss Interventional Study on Silent Ischemia Type II (SWISSI II). Because in SWISSI II patients were randomized based on a coronary anatomy “suitable for angioplasty” at the time of the study, lesion morphology as well as involved vessels were equally balanced in both groups, as shown in Table 1 of the article. Total occlusions were observed in 18% of patients in both groups. Lesion morphology classification first proposed by an American College of Cardiology/American Heart Association Task Force1 was designed to describe coronary lesions at greater or lower risk for early periprocedural complications; only later was this also linked to longer term outcome.2 In SWISSI II, angioplasty was successful in all patients, most likely because very complex lesions were not thought to be “suitable for angioplasty” by the operators in the pre-stent era 15 years ago. Thus, lesion complexity in SWISSI II was well balanced between groups, did not diminish overall angioplasty success, and thus should not have influenced long-term outcome.

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