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June 11, 1997

Can Ambulatory Monitoring Identify High-Risk Patients With Stable Coronary Artery Disease?-Reply

Author Affiliations

National Institutes of Health Bethesda, Md

JAMA. 1997;277(22):1760-1761. doi:10.1001/jama.1997.03540460026021

—We, like many other researchers, believed at the initiation of our studies that transient ischemia would be of prognostic significance, but why this was not the case is clearly stated by Drs Deedwania and Carbajal: "Acute ischemic syndromes mostly occur due to fissuring or rupture of atherosclerotic plaque," and "the risk of acute coronary events cannot be reliably predicted based on the evidence and extent of myocardial ischemia." Our findings are confirmed by those of the Multicenter Myoardial Ischemia Research Group and Total Ischemic Burden European Trial (TIBET) studies, conducted in more than 1400 patients.1,2 If one accepts that transient ischemia per se does not actually cause plaque rupture or fissuring, then it is entirely understandable that acute coronary events (due predominantly to plaque rupture/fissuring) are equally likely to occur in patients with and without ischemia. Unlike previous studies, we had followup angiographic evidence in most cases of nonfatal