Asymptomatic Ischemia in Patients With Coronary Artery Disease

ANGINA pectoris is the hallmark symptom of coronary artery disease and its frequency and severity has traditionally provided the basis for evaluation and treatment. Assessment of patients with coronary artery disease and decisions regarding their treatment are usually based on the patient's subjective account of symptoms. Studies (exercise tolerance tests, radionuclide angiography, and coronary arteriography) performed during brief visits to the clinic or hospital can only provide an indirect estimate of the patient's ischemic activity out of the hospital. Recent studies suggest that a large population of adults with coronary artery disease experience many episodes of asymptomatic or silent transient myocardial ischemia on a daily basis, apart from the events that occur with pain.¹,²Ambulatory electrocardiographic (ECG) monitoring of ST segments provides an objective measurement of transient ischemia during everyday life, and, as a result, a more extensive and detailed understanding of the pathophysiology of coronary artery disease has