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.