Silent myocardial ischemia and its relationship to acute myocardial infarction.

The preceding review indicates that silent myocardial ischemia has definite prognostic implications in both symptomatic and asymptomatic patients with coronary artery disease. Patients surviving an acute myocardial infarction are at a particularly high risk if they show evidence of myocardial ischemia. At present, many noninvasive diagnostic modalities are available to the physician for the evaluation of symptomatic and silent myocardial ischemia in such patients. Because as many as 30 per cent of patients may become asymptomatic after myocardial infarction, physicians must be aggressive in evaluating their patients for the presence of silent myocardial ischemia. The presence of silent ischemia would help identify those patients at high risk of postinfarction complications. Future use of currently available therapeutic modalities directed toward treatment of total ischemic burden on the myocardium may help lower morbidity and mortality in these patients by reducing the risk of subsequent cardiac events.