Inducible Ischemia and the Risk of Recurrent Cardiovascular Events in Outpatients With Stable Coronary Heart DiseaseThe Heart and Soul Study

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Abstract
Current guidelines do not recommend routine cardiac stress testing in asymptomatic patients with known coronary heart disease (CHD).1 However, the presence of asymptomatic ischemia has been shown to predict adverse outcomes in patients following coronary artery bypass grafting2 or percutaneous coronary revascularization3 and in diabetic patients with CHD.4 Some have suggested that ischemia-guided therapy may improve prognosis in patients with stable CHD5 and that we should consider relief of myocardial ischemia rather than relief of angina symptoms as the goal of therapy.6,7 Previous studies have found that inducible ischemia with or without angina is predictive of incident adverse cardiovascular events,8,9 but it is unknown whether inducible ischemia in the absence of self-reported angina predicts recurrent events in patients with established CHD.10