In Reply: We agree with Dr DeBusk that stress
testing—with or without sildenafil—will not identify patients
prone to plaque rupture involving nonobstructive coronary lesions. Nevertheless,
stress echocardiography has been shown to identify patients at risk of myocardial
infarction and cardiac death, which has been demonstrated in both sexes1 and in patients aged 65 years and older.2 As we acknowledged, our study was powered to detect
differences in extent and severity of ischemia with sildenafil compared with
placebo. Larger numbers of patients must be studied to determine the effect
of sildenafil on infrequently occurring clinical events.
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