Prevalence, consequences, and implications for clinical trials of unrecognized myocardial infarction
Yuri B Pride1, Bryan J Piccirillo, C Michael Gibson
1Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Insights
Unrecognized myocardial infarction (MI) is common, especially in high-risk groups, and carries risks similar to recognized MI. Early detection and consideration in clinical trials are crucial for cardiovascular health.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Diagnostic Imaging
Background:
- Myocardial infarction (MI) typically presents with chest pain, ECG changes, and elevated cardiac biomarkers.
- A significant subset of patients experience unrecognized MI with minimal symptoms or delayed medical attention.
Purpose of the Study:
- To review the incidence of unrecognized MI across diverse populations.
- To assess the subsequent risk of major adverse cardiovascular events following unrecognized MI.
- To explore the inclusion of unrecognized MI as a primary outcome in clinical trials.
Main Methods:
- Review of existing literature on unrecognized MI incidence and outcomes.
- Analysis of cardiovascular event risk in patients with unrecognized MI.
- Discussion of the potential role of unrecognized MI in clinical trial design.
Main Results:
- Unrecognized MI is a prevalent condition, affecting up to 35% in high-risk populations.
- The risk of subsequent major adverse cardiovascular events after unrecognized MI is comparable to that of clinically apparent MI.
- Diagnostic techniques like ECG and imaging can detect unrecognized MI.
Conclusions:
- Unrecognized MI is a common and significant clinical entity.
- Patients with unrecognized MI face substantial risks of future cardiovascular events.
- Consideration of unrecognized MI in clinical trials may refine assessments of cardiovascular risk reduction strategies.
Abstract:
Patients with myocardial infarction (MI) generally present with chest pain or pressure at rest or minimal exertion and have associated electrocardiographic changes and/or elevation of the biomarkers of myocardial necrosis. A subset of patients, however, experience little chest discomfort or do not present to medical attention despite experiencing symptoms. Unrecognized MI might be detected using electrocardiographic or imaging techniques, such as echocardiography, nuclear imaging, or cardiovascular magnetic resonance imaging. Unrecognized MI is a common clinical entity, with an incidence as great as 35% in high-risk populations. Moreover, the risk of a subsequent major adverse cardiovascular event might be similar to the risk after a clinically apparent MI. In the present review, we examined the incidence of unrecognized MI across broad groups of subjects and the subsequent risk of adverse cardiovascular events. Finally, we explored the potential role of including unrecognized MI as a major adverse outcome in randomized clinical trials of agents aimed at reducing cardiovascular morbidity.
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