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Unrecognized Myocardial Infarction Assessed by Cardiac Magnetic Resonance Imaging--Prognostic Implications

Anna M Nordenskjöld1, Per Hammar2, Håkan Ahlström3

  • 1Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden.

Plos One
|February 18, 2016
PubMed

Insights

Clinically unrecognized myocardial infarctions (UMI) are linked to adverse outcomes in patients with suspected coronary artery disease (CAD). However, this association weakens after accounting for CAD severity, suggesting routine UMI screening may not be necessary.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Clinical Research

Background:

  • Clinically unrecognized myocardial infarctions (UMI) are common and may indicate adverse outcomes.
  • The prognostic significance of UMI in stable suspected coronary artery disease (CAD) requires further investigation.
  • Understanding the association between UMI and the presence of CAD is crucial for patient management.

Purpose of the Study:

  • To determine the prognostic implication of UMI in patients with stable suspected CAD.
  • To investigate the association between UMI and the presence and severity of CAD.
  • To evaluate the clinical utility of late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) for UMI detection in this population.

Main Methods:

  • A cohort of 235 patients with stable suspected CAD underwent late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) and coronary angiography.
  • Stenosis grade of the coronary branch supplying infarcted areas was determined for patients with UMI.
  • Prognostic endpoints were assessed over a 2-year follow-up period.

Main Results:

  • Unrecognized myocardial infarctions (UMIs) were identified in 25% of patients.
  • The majority of UMIs (67%) were associated with coronary arteries having ≥70% stenosis.
  • In initial analysis, UMI independently predicted adverse events (OR 2.9), but this was not significant after adjusting for age and significant CAD.
  • No difference in adverse event rates was observed between UMI patients with or without significant stenosis in the corresponding artery.

Conclusions:

  • The initial association between UMI and adverse events was not sustained after adjustment for CAD severity.
  • Routine LGE-CMR for UMI detection is not supported in patients with suspected CAD.
  • Coronary angiography should be considered for patients with UMI identified by LGE-CMR.
Abstract

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