Objective To investigate the clinical features of silent myocardial ischemia(SMI) in elderly patients with coronary heart disease(CHD) and the unfavorable prognostic factors for recurrent heart events,such as acute myocardial infarction(AMI) or sudden cardiac death(SCD).Methods A total of 216 elderly CHD patients with SMI were followed up for 2-7(mean 5.01) years.The clinical features,including age,gender,systemic hypertension,diabetes mellitus,hyperlipidemia,smoking,history of myocardial infarction,complex ventricular arrhythmia attack,left ventricular hypertrophy,frequency and ischemia duration of SMI,and degree of ST segment depression,as well as Holtor′s parameters,were recorded.The occurrence of AMI and SCD were also noted.Results There were 27 patients who sufferred AMI or SCD at the end of follow-up.The accumulative incidence of recurrent heart events was 14.54% during 7-year follow-up.Cox multivariable regression analysis showed that age,left ventricular hypertrophy,history of myocardial infarction,and hyperlipidemia were independent risk factors for recurrent heart events.Conclusion It would be helpful to improve the prognosis of elderly CHD patients with SMI to remove or alleviate these negative prognostic factors.