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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
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.
Objectives:
This study was designed to determine the prevalence of unrecognized myocardial infarction (UMI), as well as risk factors, and to compare prognosis after detection of previously UMI to that after recognized myocardial infarction (RMI).
Background:
Past studies revealed that a significant proportion of MIs escape recognition, and that prognosis after such events is poor, but the epidemiology of UMI has not been reassessed in the contemporary era.
Methods:
The Cardiovascular Health Study (CHS) database, composed of individuals > or =65, was queried for participants who, at entry, demonstrated electrocardiographic evidence of a prior Q-wave MI, but who lacked a history of this diagnosis. The features and outcomes of this group were compared to those of individuals with prevalent RMI.
Results:
Of 5,888 participants, 901 evidenced a past MI, and 201 (22.3%) were previously unrecognized. The independent predictors of UMI were the absence of angina and the absence of congestive heart failure (CHF). Six-year mortality did not significantly differ between the two groups.
Conclusions:
1) In the elderly, UMI continues to represent a significant proportion of all MIs; 2) associations with angina and CHF may reflect complex neurological issues, but they also may represent diagnosis bias; 3) these individuals can otherwise not be distinguished from those with recognized infarctions; and 4) mortality rates after UMI and RMI are similar. Future studies should address screening for UMI, risk stratification after detection of previously UMI, and the role of standard post-MI therapies.