Silent ischaemia in asymptomatic 'healthy' individuals with coronary risk factors

On the occasion of a routine medical check-up 256 out of 1100 individuals with an accumulation of coronary risk factors were screened for silent myocardial ischaemia by exercise testing and Holter monitoring. Of these individuals 5.5% had a pathological exercise test, 7.4% had ischaemia-like events on the Holter ECG, 11.3% had at least one pathological test, but only 1.6% had ischaemic signs in both ECG tests. The outcome of the ECG tests appears to be independent of the type and the total number of risk factors. To date, 13 of the 29 individuals with a positive test have undergone thallium myocardial imaging: only three individuals had signs of ischaemia. Holter monitoring and exercise ECG show comparable results in this population. The pathological ECG findings were only partly confirmed by the thallium test. The follow-up will show the prognostic significance of the ECG changes.