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Prevalence, predisposing factors, and prognosis of clinically unrecognized myocardial infarction in the elderly

S E Sheifer1, B J Gersh, N D Yanez

  • 1Division of Cardiology, Georgetown University Medical Center, Washington, DC 20007, USA. sheifers@gusun.georgetown.edu

Journal of the American College of Cardiology
|January 15, 2000
PubMed

Insights

Unrecognized myocardial infarction (UMI) is common in the elderly, affecting over 20%. Prognosis after detecting UMI is similar to recognized myocardial infarction (RMI), indicating a need for better screening strategies.

Area of Science:

  • Cardiology
  • Geriatric Medicine
  • Epidemiology

Background:

  • A significant proportion of myocardial infarctions (MIs) go unrecognized.
  • Prognosis for unrecognized myocardial infarction (UMI) is historically poor.
  • Contemporary epidemiology of UMI requires reassessment.

Purpose of the Study:

  • Determine the prevalence of unrecognized myocardial infarction (UMI) in the elderly.
  • Identify risk factors associated with UMI.
  • Compare the prognosis of UMI to recognized myocardial infarction (RMI).

Main Methods:

  • Utilized the Cardiovascular Health Study (CHS) database.
  • Included participants aged 65 and older.
  • Compared individuals with electrocardiographic evidence of prior Q-wave MI but no prior diagnosis (UMI) to those with a history of recognized myocardial infarction (RMI).

Main Results:

  • 22.3% of participants with a past MI had unrecognized myocardial infarction (UMI).
  • Independent predictors for UMI included absence of angina and absence of congestive heart failure (CHF).
  • Six-year mortality rates were similar between UMI and RMI groups.

Conclusions:

  • UMI remains a significant issue in the elderly population.
  • Absence of angina and CHF may be associated with UMI, potentially due to diagnostic bias or complex neurological factors.
  • Individuals with UMI have similar outcomes to those with RMI, suggesting a need for improved screening and risk stratification.
Abstract

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