INITIAL CLINICAL PRESENTATION OF CARDIAC DISEASE IN ASYMPTOMATIC MEN WITH SILENT-MYOCARDIAL-ISCHEMIA AND ANGIOGRAPHICALLY DOCUMENTED CORONARY-ARTERY DISEASE (THE OSLO ISCHEMIA STUDY)

Data concerning the natural history of asymptomatic coronary artery di sease (CAD) has been limited to epidemiologic rather than angiographic studies, thus leading to uncertainty as to whether warning symptoms a nd signs will identify subjects with silent myocardial ischemia before morbid events. To address this issue, 50 apparently healthy men with angiographically proven CAD and asymptomatic exercise-induced ST depre ssion have been followed prospectively for 15 years in the Oslo Ischem ia Study. Fourteen men died. The initial presenting clinical event in these 14 men was chest pain in 4 (30%) - but in only 1 case was it rec ognized as typical angina - silent myocardial infarction in 5 (35%) an d sudden death in 5 (35%). Thirty-six men survived, with 19 developing symptoms. Overall, chest pain was the first clinical event in 22 of t he total of 33 men with symptoms (66%), whereas myocardial infarction occurred in 6 (18%) and sudden death in 5 (16%). Although chest pain o ccurred in 22 men, it was clinically diagnosed as typical angina pecto ris in only 6. These observations suggest that there is an absence of clear-cut ischemic symptoms in many asymptomatic patients before morbi d events.