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Silent MI. Prevalence and prognosis in older patients diagnosed by routine electrocardiograms
1Department of Medicine, Cardiology and Geriatrics Divisions, New York Medical College, Valhalla, NY, USA.
Insights
Silent myocardial ischemia in older adults with coronary artery disease increases the risk of new coronary events. Unrecognized heart attacks in this population warrant aggressive diagnosis and treatment for better outcomes.
Area of Science:
- Cardiology
- Geriatric Medicine
- Diagnostic Imaging
Background:
- Coronary artery disease (CAD) is a significant health concern in older populations.
- Silent myocardial ischemia, often undetected, poses a risk for future cardiac events.
- Clinically unrecognized myocardial infarction (MI) prevalence in older adults ranges widely.
Purpose of the Study:
- To investigate the association between silent myocardial ischemia and new coronary events in older adults with CAD.
- To compare outcomes of unrecognized MI with recognized MI in the elderly.
- To evaluate the potential benefit of aggressive diagnostic and therapeutic strategies.
Main Methods:
- Utilized 24-hour ambulatory electrocardiograms (ECGs) to detect silent myocardial ischemia.
- Assessed the incidence of new coronary events in older men and women with and without silent ischemia.
- Compared event rates and mortality in patients with recognized versus unrecognized MI.
Main Results:
- Older individuals with silent myocardial ischemia showed a higher incidence of new coronary events.
- The prevalence of unrecognized MI in older persons varied significantly (21-68%).
- Unrecognized MI in older adults was associated with similar or higher rates of new coronary events and mortality compared to recognized MI.
Conclusions:
- Silent myocardial ischemia is a significant risk factor for adverse cardiac outcomes in older adults with CAD.
- Atypical symptoms like dyspnea, neurologic, and GI issues can indicate MI in the elderly.
- Aggressive diagnostic and therapeutic approaches are recommended for older patients with unrecognized MI.
Abstract:
Older men and women with coronary artery disease and silent myocardial ischemia detected by 24-hour ambulatory electrocardiograms (ECGs) have a higher incidence of new coronary events than those with no silent ischemia. The prevalence of clinically unrecognized MI detected by routine ECGs in older persons varies from 21 to 68%. Atypical symptoms associated with acute MI in older persons include dyspnea and neurologic and GI symptoms, as well as chest pain. Older persons with clinically unrecognized MI have a similar or higher incidence of new coronary events and mortality compared with those with recognized MI, which suggests that an aggressive diagnostic and therapeutic approach may be beneficial in these patients.