Asymptomatic electrocardiographic ischemia and silent myocardial ischemia.

Silent myocardial ischemia is undoubtedly the second most prevalent cardiovascular disease after arterial hypertension. Considering its statistical and social importance, the authors, while admitting the less specific coronary character of this entity, do not agree with its being omitted from the last classification of coronary disease (1979), in which especially/angina pectoris and myocardial infarction are emphasized. In the present paper, which opens up an investigation into initially silent ischemia carried out on a great number of cases, the authors discuss the preliminary observations derived from a ten-year (1976-1986) follow up of 56 cases of initially asymptomatic electrocardiographic ischemia with an electric localization suggesting specific coronary territories. It results that the incidence of an unfavourable evolution (myocardial infarction, angina pectoris, onset of arrhythmias or conduction defects) is somewhat higher in males than in females, but not up to 3-4 times as stated in most populational studies on myocardial infarction. The electrocardiographic and clinical improvements are, however, definitely more frequent (4 times) in women than in men (p less than 0.002). Of the 56 cases studied, 26.6% worsened, 23.2% improved, and 21.5% presented no change along the 10 years of follow up (the others showed electrocardiographic evolutions without a clinical expression, while 2 died from a noncardiac cause.