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October 20, 1993

Noninvasive Testing for Silent Myocardial Ischemia in Stable Coronary Patients-Reply

JAMA. 1993;270(15):1810. doi:10.1001/jama.1993.03510150043016

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In Reply.  —The letters of Leppo et al and Thompson emphasize that the purpose and methods of a clinical study are crucial in defining the meaning of that study's findings. When planning our study, we were impressed that considerable uncertainty exists regarding the clinical significance of silent myocardial ischemia in stable coronary patients. To address this uncertainty, we chose to study an intermediate-risk coronary population, ie, those who are clinically stable several months after an acute coronary event but are at risk for recurrent coronary events. This group of patients is frequently evaluated by noninvasive testing for evidence of myocardial ischemia prior to return to work or full activity, with the implication that the detection of myocardial ischemia has important prognostic implications. We observed myocardial ischemia in 41% of the study patients by stress thallium-201 scintigraphy, in 29% by exercise ECG, and in 8% by ambulatory ECG. The 2-year event