Prognostic significance of silent ischemia in elderly patients with peripheral arterial disease with and without previous myocardial infarction

Early postoperative silent myocardial ischemia detected by ambulatory electrocardiography (ECG) in patients undergoing peripheral vascular surgery for occlusive peripheral arterial disease (PAD) is associated with clinical ischcmic events after surgery.¹ Patients undergoing peripheral vascular surgery who had silent myocardial ischemia before surgery detected by ambulatory ECG had an increased incidence of major postoperative cardiac events after surgery.² At a mean follow-up of 615 days after peripheral vascular surgery, cardiac events occurred in 12 of 32 (38%) patients with ischemia before surgery detected by ambulatory ECG and in 10 of 144 (7%) without myocardial ischemia (relative risk 5.4).³ We are reporting data from a prospective study correlating silent myocardial ischemia detected by 24-hour ambulatory ECG with the incidence of new coronary events at a 43-month mean follow-up in elderly patients with PAD and coronary artery disease (CAD) and in those with PAD and hypertension, valvular heart disease or cardiomyopathy without CAD.