Abstract
BackgroundIndividuals with unrecognized myocardial infarctions (UMIs) detected with cardiovascular magnetic resonance (CMR) constitute a recently defined group whose prognosis has not been fully evaluated. However, increasing evidence indicate that these individuals may be at considerable cardiovascular risk. The aim of the present study was to investigate the prognostic impact of CMR detected UMIs for major adverse cardiac events (MACE) in community living elderly individuals.MethodsLate gadolinium enhancement CMR was performed in 248 randomly chosen 70-year-olds. Individuals with myocardial infarction (MI) scars, with or without a hospital diagnosis of MI were classified as recognized MI (RMI) or UMI, respectively. Medical records and death certificates were scrutinized. MACE was defined as cardiac death, non-fatal MI, a new diagnosis of angina pectoris, or symptom-driven coronary artery revascularization.ResultsDuring follow-up (mean 11 years) MACE occurred in 10 % (n = 18/182) of the individuals without MI scars, in 20 % (n = 11/55) of the individuals with UMI, and in 45 % (n = 5/11) of the individuals with RMI, with a significant difference between the UMI group and the group without MI scars (p = 0.045), and between the RMI group and the group without MI scars (p = 0.0004). Cardiac death and/or non-fatal MI occurred in 15, 5, and 3 of the individuals in the NoMI, UMI, and RMI group respectively. Hazards ratios for MACE adjusted for risk factors and sex were 2.55 (95 % CI 1.20-5.42; p = 0.015) for UMI and 3.28 (95 % CI1.16-9.22; p = 0.025) for RMI.ConclusionsThe presence of a CMR detected UMI entailed a more than double risk for MACE in community living 70-year-old individuals.
Highlights
Individuals with unrecognized myocardial infarctions (UMIs) detected with cardiovascular magnetic resonance (CMR) constitute a recently defined group whose prognosis has not been fully evaluated
A number of studies have been conducted in selected risk populations establishing CMR detected UMIs as an important risk factor for major adverse cardiac events (MACE)
One epidemiology study on the prognostic impact of CMR detected UMIs has been published. It was performed in a mixed cohort with randomly chosen participants and diabetes patients and it reveals an increased all-cause mortality risk in elderly individuals with UMI compared to those without MI [5]
Summary
Individuals with unrecognized myocardial infarctions (UMIs) detected with cardiovascular magnetic resonance (CMR) constitute a recently defined group whose prognosis has not been fully evaluated. A number of studies have been conducted in selected risk populations establishing CMR detected UMIs as an important risk factor for major adverse cardiac events (MACE). This has been demonstrated in patients with confirmed [9, 10] or suspected [9,10,11] coronary artery disease, in patients with peripheral arterial occlusive. One epidemiology study on the prognostic impact of CMR detected UMIs has been published It was performed in a mixed cohort with randomly chosen participants and diabetes patients and it reveals an increased all-cause mortality risk in elderly individuals with UMI compared to those without MI [5]. To the best of our knowledge, this is the first study to investigate the relationship between CMR detected UMIs and cardiac death or other severe cardiac events in long-term follow-up of an entirely population based cohort
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