[Long-term prognosis of patients with silent ischemia].

To study the long-term evolution in patients with silent ischemia we investigated 242 coronary patients showing ischemic signs on exercise T1-201 scintigraphy. The findings in a group of 106 patients with angina were compared with those in a group of 136 patients without angina during exercise and followed up for an average of 60 months. Multiple comparisons of clinical features, ECG, hemodynamic and angiographic data showed no significant differences between the two groups. However, the extent of ischemia detected by T1-201 was significantly smaller in patients with silent ischemia although their work-load and double product were higher.--During the follow-up cardiac mortality (11% vs 11%), unstable angina (27% vs 20%) and myocardial infarction (23% vs 20%) were found with the same frequency in patients with angina compared with those with silent ischemia. Bypass surgery was performed more frequently (55% vs 37%) in patients with symptomatic ischemia. Long-term evolution in our coronary patients with episodes of silent ischemia was similar to that in patients with ischemia accompanied by angina, and showed numerous complications. Therefore, we should try to treat not only angina but also, and especially, ischemia.