[Silent ischemia. To treat or not to treat?].

Silent myocardial ischaemia can be defined as the presence of transient ischaemic alterations in absence of angina. Those include metabolic, functional, electrocardiographic and anatomic abnormalities without typical chest pain. Its incidence, prognostic significance, possible identification in clinical practice as well as need for treatment varies according to the group of patients. In the present review, we discuss these concepts in base of the knowledge supported by the results of different studies. As a rule, the incidence, prognostic significance, and henceforth the need for its identification, increase from the low risk groups of patients to those of high risk according to classical criteria. To this respect, it is useful to differentiate three groups of patients: normal subjects, stable coronary heart disease and unstable heart disease. Medical treatment with anti-ischaemic drugs as well as myocardium revascularization procedures have shown to decrease the incidence and severity of silent myocardial ischaemia, but its influence on prognosis is unknown, and it should be emphasized that the main objective in the treatment of silent ischaemia is improve prognosis.