Silent myocardial ischemia: dimensions of the problem in patients with and without angina.

Because of its possible relation to sudden cardiac death, silent myocardial ischemia is an important public health issue, especially with regard to persons who are totally asymptomatic. However, this syndrome is not confined to individuals without prior histories of angina or myocardial infarction; it is also being reported with increasing frequency in patients with clinical evidence of coronary artery disease. Although prognostic studies of silent myocardial ischemia in patients with angina are currently in progress, it appears that patients with extensive disease and left ventricular dysfunction are at highest risk for subsequent cardiac events.