[Silent myocardial ischemia].

During the last few years, the concept of "silent myocardial ischemia" has received special attention, particularly regarding its prognostic implications. Unfortunately a great variety of patients in different clinical settings have been included under the same definition. Thus, totally asymptomatic individuals are considered together with patients who have clinically evident stable or unstable angina pectoris, or patients in the post myocardial infarction phase. As a consequence, prognostic observations derived from clearly symptomatic cases are extrapolated to asymptomatic individuals in whom the only evidence of underlying coronary disease is an abnormal ECG stress test. The prognostic information available in this particular group shows that their clinical course is usually benign. Thus, invasive forms of investigation and management are not generally justified, in patients with properly define "silent myocardial ischemia".