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The diagnosis of silent myocardial ischemia in the aged remains controversial. In this study to evaluate the basic state of silent ischemia in the aged, a total of 972 consecutive autopsy cases (mean 79.0 yrs of age) were analyzed in terms of coronary atherosclerotic diseases. The following results were obtained: (1) Severe coronary occlusive lesions simultaneously detected in the three major coronary arterial branches were found in 85 cases (8.7%), of which 10 (12%) had neither history of angina nor myocardial infarction (MI), which may correspond to one representation of silent ischemia. (2) There were 218 cases of MI (22.4%), of which 106 (49%) were never documented to have MI during life. The latter may correspond to unrecognized MI. It was considered to be caused by 1) small or middle-sized MI in 66 cases and 2) lateral or nontransmural MI in 29 out of 40 large MI cases (more than 4.9 cm in diameter). (3) 30 cases (54%) out of 56 fresh and large MI with a correct diagnosis revealed no chest pain. This is an incidence of painless MI in the aged. This painless group showed a significant difference in the incidence of a correct diagnosis of MI (51% vs 89%), combined arrhythmia (47% vs 79%) and the association of CVD (47% vs 11%) compared with chest pain group.

Silent myocardial ischemia in the aged: A retrospective study from the evaluation of necropsy hearts.