Asymptomatic myocardial ischemia in the elderly

Silent myocardial ischemia (SMI) in the elderly refers to the presence of objective evidence of myocardial ischemia without angina pectoris or related symptoms. The incidence of SMI in the elderly is higher than in middle-aged and young people, partly related to damage to the pain warning system caused by advanced age, myocardial infarction, diabetes, and other reasons. SMI is quite common, with an incidence of 2.5% to 10% in the general population; among patients with coronary heart disease, it is as high as 60% to 80%, of which 75% have angina (only 25% are symptomatic), 90% have unstable angina, 20% to 30% have acute myocardial infarction, and in old myocardial infarction, SMI is 4.7 times more common than symptomatic ischemia. The incidence of SMI in the elderly is higher than in middle-aged and young people, partly related to damage to the pain warning system caused by advanced age, myocardial infarction, diabetes, and other reasons.