Abstract
Introduction: Silent myocardial infarction (SMI) on electrocardiogram (ECG) is associated with atherosclerotic cardiovascular disease, but the relationship between SMI on ECG and coronary artery calcium (CAC) remains poorly understood. Hypothesis: SMI on ECG is predictive of elevated CAC. Methods: Eligible participants from the Multi-Ethnic Study of Atherosclerosis (MESA) had ECG and CAC scoring at study enrollment (2000-2002). SMI was defined as ECG evidence of myocardial infarction in the absence of a history of clinical cardiovascular disease. CAC was modeled both continuously and categorically. The cross-sectional relationships between SMI on ECG and CAC were assessed using logistic regression and linear regression. Results: Among 6,705 eligible participants, 178 (2.7%) had baseline SMI. Compared to participants without SMI, those with SMI had higher CAC (median [IQR]: 61.2 [0 - 261.7] vs. 0 [0 - 81.5]; p < 0.0001). Participants with SMI were more likely to have non-zero CAC (74% vs. 49%) and were more likely to have CAC ≥ 100 (40% vs. 23%). In a multivariable-adjusted logistic model, SMI was associated with higher odds of non-zero CAC (odds ratio 2.17, 95% CI 1.48 - 3.20, p < 0.0001) and 51% higher odds of CAC ≥ 100 (odds ratio 1.51, 95% CI 1.06 - 2.16, p = 0.02). Conclusions: An incidental finding of SMI on ECG may serve to identify patients who have a higher odds of significant CAC and may benefit from additional risk-stratification to further refine their cardiovascular risk. Further exploration of the utility of CAC assessment in this patient population is needed.
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