Silent myocardial ischemia as a manifestation of asymptomatic coronary artery disease: what is appropriate therapy?

Silent myocardial ischemia is one of the most important clinical manifestations of asymptomatic coronary artery disease, along with silent myocardial infarction. It may well be a forerunner of sudden cardiac death. Although our understanding of the pathophysiologic mechanisms of the syndrome is still unresolved, we do know that prognosis in certain subsets of patients is far from benign. For that reason, aggressive therapy is recommended in asymptomatic patients with advanced disease, especially if they have already experienced a myocardial infarction, silent or otherwise.