Small and large vessel disease in persons with unrecognized compared to recognized myocardial infarction: The Tromsø Study 2007–2008

Øhrn, Andrea Milde; Schirmer, Henrik; Hanno, Therese von; Mathiesen, Ellisiv B.; Arntzen, Kjell Arne; Bertelsen, Geir; Njølstad, Inger; Løchen, Maja‐Lisa; Wilsgaard, Tom; Merz, C. Noel Bairey; Lindekleiv, Haakon

doi:10.1016/j.ijcard.2017.10.009

Cited by 13 publications

(6 citation statements)

References 51 publications

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“…The progressive convergence of the UMI and RMI mortality curves may have 2 possible mechanisms. First, as suggested in previous studies, UMI may represent a different coronary disease phenotype with more small-vessel involvement and atrial fibrillation than RMI and thus chart a different natural course . Because of a lower epicardial plaque burden (lower CAC) than RMI at baseline, UMI event rates may lag behind RMI and increase after a delay.…”

Section: Discussionmentioning

confidence: 85%

Association of Unrecognized Myocardial Infarction With Long-term Outcomes in Community-Dwelling Older Adults

et al. 2018

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IMPORTANCE Cardiac magnetic resonance (CMR) imaging can identify unrecognized myocardial infarction (UMI) in the general population. Unrecognized myocardial infarction by CMR portends poor prognosis in the short term but, to our knowledge, long-term outcomes are not known. OBJECTIVE To determine the long-term outcomes of UMI by CMR compared with clinically recognized myocardial infarction (RMI) and no myocardial infarction (MI). DESIGN, SETTING, AND PARTICIPANTS Participants of the population-based, prospectively enrolled ICELAND MI cohort study (aged 67–93 years) were characterized with CMR at baseline (from January 2004-January 2007) and followed up for up to 13.3 years. Kaplan-Meier time-to-event analyses and a Cox regression were used to assess the association of UMI at baseline with death and future cardiovascular events. MAIN OUTCOMES AND MEASURES The primary outcome was all-cause mortality. Secondary outcomes were a composite of major adverse cardiac events (MACE: death, nonfatal MI, and heart failure). RESULTS Of 935 participants, 452 (48.3%) were men; the mean (SD) age of participants with no MI, UMI, and RMI was 75.6 (5.3) years, 76.8 (5.2) years, and 76.8 (4.7) years, respectively. At 3 years, UMI and no MI mortality rates were similar (3%) and lower than RMI rates (9%).At 5 years, UMI mortality rates (13%) increased and were higher than no MI rates (8%) but still lower than RMI rates (19%). By 10 years, UMI and RMI mortality rates (49% and 51%, respectively) were not statistically different; both were significantly higher than no MI (30%) (P <.001). After adjusting for age, sex, and diabetes, UMI by CMR had an increased risk of death (hazard ratio [HR], 1.61; 95% CI, 1.27–2.04), MACE (HR, 1.56; 95% CI, 1.26–1.93), MI (HR, 2.09; 95% CI, 1.45–3.03), and heart failure (HR, 1.52; 95% CI, 1.09–2.14) compared with no MI and statistically nondifferent risk of death (HR, 0.99; 95% CI, 0.71–1.38) and MACE (HR, 1.23; 95% CI, 0.91–1.66) vs RMI. CONCLUSIONS AND RELEVANCE In this study, all-cause mortality of UMI was higher than no MI, but within 10 years from baseline evaluation was equivalent with RMI. Unrecognized MI was also associated with an elevated risk of nonfatal MI and heart failure. Whether secondary prevention can alter the prognosis of UMI will require prospective testing.

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Section: Discussionmentioning

confidence: 85%

Association of Unrecognized Myocardial Infarction With Long-term Outcomes in Community-Dwelling Older Adults

et al. 2018

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“…This association may be linked to a worse prognosis in patients with UMI, irrespective of the presence or absence of ischemia or its severity 2 . Microvascular disease has been also postulated to be a mechanism underlying the link between UMI as a marker of advanced atherosclerosis and poor prognosis 20 . A population-based study found an association between UMI and cerebral infarction 21 .…”

Section: Discussionmentioning

confidence: 99%

Prognostic implications of unrecognized myocardial infarction before elective percutaneous coronary intervention

Nogami

Hoshino

Kanaji

et al. 2022

Sci Rep

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Unrecognized myocardial infarction (UMI) is associated with adverse outcomes. This prospective, single-center study elucidated the prevalence and prognostic significance of UMI before elective percutaneous coronary intervention (PCI) using delayed-enhancement cardiac magnetic resonance (DE-CMR). We enrolled 236 patients with stable coronary artery disease who underwent DE-CMR before elective PCI. The prevalence of UMI and the association of clinical and CMR-derived variables with major adverse cardiac events (MACE), defined as cardiovascular death, nonfatal MI, hospitalization for congestive heart failure, and unplanned late revascularization, were assessed. Final analysis revealed that 63/213 (29.6%) patients had UMI. Target territory UMI was observed in 38 patients (17.8% of the total cohort, 60.3% of patients with UMI). UMI was significantly associated with sex, diabetes mellitus, left ventricular ejection fraction, SYNTAX score, and fractional flow reserve in the target vessels. During follow-up (median, 23 months), MACE occurred in 17 (27.0%) patients with UMI and 17 (11.3%) without UMI (P = 0.001). Multivariable modeling revealed that UMI (hazard ratio: 2.18, 95%CI, 1.10–4.33, P = 0.001) was an independent predictor of MACE. Kaplan–Meier analysis indicated that the presence of UMI was significantly associated with a higher incidence of MACE. UMI was independently associated with a greater risk of MACE after successful PCI.

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“…Patients with clinical MI usually have typical symptoms, changes in ECG, and/or alteration in cardiac biomarkers for personalized treatment and management [36] . Conversely, some patients with silent MI have no or mild symptoms often do not seek medical attention [37] . Studies have shown that silent MI accounts for about half of all MIs [34] , [38] , [39] , [40] , and the outcome of these patients is similar to or even worse than that of patients with clinical MI [37] , [40] , [41] , [42] , [43] .…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, some patients with silent MI have no or mild symptoms often do not seek medical attention [37] . Studies have shown that silent MI accounts for about half of all MIs [34] , [38] , [39] , [40] , and the outcome of these patients is similar to or even worse than that of patients with clinical MI [37] , [40] , [41] , [42] , [43] . Therefore, clinical manifestation is an important method for classifying MI to promote the understanding of the difference between clinical MI and silent MI, which helps to improve the diagnosis of silent MI.…”

Section: Discussionmentioning

confidence: 99%

MIKB: A manually curated and comprehensive knowledge base for myocardial infarction

Zhan

Zhang

Liu

et al. 2021

Computational and Structural Biotechnology Journal

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Small and large vessel disease in persons with unrecognized compared to recognized myocardial infarction: The Tromsø Study 2007–2008

Cited by 13 publications

References 51 publications

Association of Unrecognized Myocardial Infarction With Long-term Outcomes in Community-Dwelling Older Adults

Association of Unrecognized Myocardial Infarction With Long-term Outcomes in Community-Dwelling Older Adults

Prognostic implications of unrecognized myocardial infarction before elective percutaneous coronary intervention

MIKB: A manually curated and comprehensive knowledge base for myocardial infarction

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