Silent myocardial ischemia is a transient impairment of perfusion, metabolism, function, or electrical activity of the myocardium, which is not accompanied by an angina attack or its equivalent. The SMI, as well as angina, is based on the atherosclerotic coronary artery disease. Silent myocardial ischemia increases the risk of sudden death by 10 times, arrhythmias - by 2 times, development of myocardial infarction and congestive heart failure - by 1-1.5 times. A review of recent publications devoted to the features of CA disease in patients with SMI according to the CAG has been conducted. CAG data for 33 patients with SMI, who underwent an examination from January 2014 to December 2015 in State Autonomous Healthcare Institution " Interregional Clinical and Diagnostic Center", have been retrospectively analyzed. The literature data on the severity of atherosclerotic lesions according to coronary angiography in patients with silent myocardial ischemia are contradictory. It is not clear, whether a high degree of stenosis of the coronary arteries or multivessel disease prevails in these patients. The own data support the view of multivessel coronary artery disease in patients with silent myocardial ischemia, with a predominance of lesions of the right coronary artery and the left anterior descending artery with a high level of critical stenosis. The inconsistency of the available data on the severity of coronary lesions in patients with silent ischemia, according to the current literature, requires further study and, therefore, the continued investigation.