The prognostic significance of silent myocardial ischemia detected during graded exercise testing (GXT) is uncertain. The angiographic characteristics and long-term follow-up of 83 patients with silent ischemia (group 1), mean age 58 ± 9 years, were compared with 83 age- and sex-matched patients with typical angina pectoris (group 2). Basic characteristics and mean follow-up (42 ± 22 months) were similar in both groups. Patients with silent ischemia were characterized by longer duration of exercise test (6.5 vs. 4.8 min, p < 0.01), larger extent of maximum ST depression during peak exercise (2.4 vs. 2.0 mm, p < 0.01) and higher maximal double product at peak exercise (24,650 vs. 20,825, p < 0.01) compared to group 2. Long-term follow-up revealed similar rates of mortality (3.6 vs. 4.8%, p = NS) and major cardiac events (19.3 vs. 21.7%, p = NS). However, patients with typical angina tended to have more revascularization procedures (81 vs. 61 %, p < 0.1). Thus, patients with silent ischemia have a better GXT capacity compared to patients with typical angina pectoris. Despite a similar severity of coronary involvement, patients with typical angina pectoris tend to have more revascularization procedures, yet the long-term prognosis appears similar.