Prevalence and incidence of Q-wave unrecognized myocardial infarction in general population: Diagnostic value of the electrocardiogram. The REGICOR study

Ramos, Rafael; Albert, X; Sala, Joan; García-Gil, Maria; Elosúa, Roberto; Marrugat, Jaume; Ponjoan, Anna; Grau, María; Morales, Manel; Rubió, Antoni; Ortuño, Pedro Antonio Hellín; Alves-Cabratosa, Lia; Martí-Lluch, Ruth

doi:10.1016/j.ijcard.2016.10.005

Cited by 11 publications

(11 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It has been estimated that ECG features of MI disappear within two years in 10% of subjects with anterior MI and in 25% of those with an inferior MI [ 29 ]. In a recent study, opportunistic identification of asymptomatic Q-waves by routine ECG were demonstrated to clearly overestimate UMI (detected with different imaging technics as gold standard), especially in those with at low cardiovascular risk [ 30 ]. Therefore, a comparison between the prevalence and prognostic value of ECG-detected and LGE-CMR-detected UMIs is difficult.…”

Section: Resultsmentioning

confidence: 99%

Unrecognized myocardial infarction assessed by cardiac magnetic resonance imaging is associated with adverse long-term prognosis

et al. 2018

View full text Add to dashboard Cite

BackgroundUnrecognized myocardial infarctions (UMIs) are common. The study is an extension of a previous study, aiming to investigate the long-term (>5 year) prognostic implication of late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) detected UMI in patients with suspected stable coronary artery disease (CAD) without previously diagnosed myocardial infarction (MI).MethodsIn 235 patients with suspected stable CAD without previous MI, LGE-CMR imaging and coronary angiography were performed. LGE with a subendocardial component detectable in more than one imaging plane was required to indicate UMI. The stenosis grade of the coronary arteries was determined, including in the artery supplying an infarcted area. Stenosis ≥70% stenosis was considered significant. Patients were followed for 5.4 years in mean regarding a composite endpoint of cardiovascular death, MI, hospitalization due to heart failure, stable or unstable angina.ResultsUMI were present in 58 of 235 patients (25%). Thirty-nine of the UMIs were located downstream of a significant coronary stenosis. During the follow-up 40 patients (17.0%) reached the composite endpoint. Of patients with UMI, 34.5% (20/58) reached the primary endpoint compared to 11.3% (20/177) of patients with no UMI (HR 3.7, 95% CI 2.0–6.9, p<0.001). The association between UMI and outcome remained (HR 2.3, 95% CI 1.2–4.4, p = 0.012) after adjustments for age, gender, extent of CAD and all other variables univariate associated with outcome. Sixteen (41%) of the patients with an UMI downstream of a significant stenosis reached the endpoint compared to four (21%) patients with UMI and no relation to a significant stenosis (HR 2.4, 95% CI 0.8–7.2, p = 0.12).ConclusionThe presence of UMI was independently associated with an increased risk of cardiovascular events during long-term follow up.

show abstract

Section: Resultsmentioning

confidence: 99%

Unrecognized myocardial infarction assessed by cardiac magnetic resonance imaging is associated with adverse long-term prognosis

et al. 2018

View full text Add to dashboard Cite

show abstract

“…The potential benefits and harms of preventive treatment for older people at high risk of a first primary CVD event also apply to those with prior history of CVD; and the probability of either of these classifications increases with age (along with prevalence of undiagnosed ‘silent’ events [41] which carry a similar prognosis to clinical events–these are especially likely where there is a history of clinical CVD or a person is at high risk of a first primary event [42]). A qualitative focus group study of secondary CVD prevention in older people found similar dilemmas and uncertainties about the potential benefits and harms of secondary cardiovascular prevention, with management often based on frailty rather than chronological age [43].…”

Section: Discussionmentioning

confidence: 99%

General Practitioners’ Decision Making about Primary Prevention of Cardiovascular Disease in Older Adults: A Qualitative Study

et al. 2017

View full text Add to dashboard Cite

BackgroundPrimary cardiovascular disease (CVD) prevention in older people is challenging as they are a diverse group with varying needs, frequent presence of comorbidities, and are more susceptible to treatment harms. Moreover the potential benefits and harms of preventive medication for older people are uncertain. We explored GPs’ decision making about primary CVD prevention in patients aged 75 years and older.Method25 GPs participated in semi-structured interviews in New South Wales, Australia. Transcribed audio-recordings were thematically coded and Framework Analysis was used.ResultsAnalysis identified factors that are likely to contribute to variation in the management of CVD risk in older people. Some GPs based CVD prevention on guidelines regardless of patient age. Others tailored management based on factors such as perceptions of prevention in older age, knowledge of limited evidence, comorbidities, polypharmacy, frailty, and life expectancy. GPs were more confident about: 1) medication and lifestyle change for fit/healthy older patients, and 2) stopping or avoiding medication for frail/nursing home patients. Decision making for older patients outside of these categories was less clear.ConclusionOlder patients receive different care depending on their GP’s perceptions of ageing and CVD prevention, and their knowledge of available evidence. GPs consider CVD prevention for older patients challenging and would welcome more guidance in this area.

show abstract

“…Unrecognised myocardial infarction is defined as myocardial infarction that was not detected during the acute phase because typical symptoms were lacking, but was later identified by pathological Q waves on an electrocardiogram, myocardial imaging evidence, or pathological findings on autopsy. 1 2 Previous studies have shown that unrecognised myocardial infarction accounts for one third to one half of all myocardial infarctions, [1][2][3][4] especially in patients with diabetes and those of older age. 5 6 Some epidemiological studies have shown that unrecognised myocardial infarction detected by electrocardiography (UMI-ECG) is associated with subsequent increased risks of all cause mortality, recurrent cardiovascular disease, and heart failure, [7][8][9] although other studies found null associations.…”

Section: Introductionmentioning

confidence: 99%

Prognosis of unrecognised myocardial infarction determined by electrocardiography or cardiac magnetic resonance imaging: systematic review and meta-analysis

Yang

Zhu

et al. 2020

BMJ

View full text Add to dashboard Cite

ObjectiveTo evaluate the prognosis of unrecognised myocardial infarction determined by electrocardiography (UMI-ECG) or cardiac magnetic resonance imaging (UMI-CMR).DesignSystematic review and meta-analysis of prospective studies.Data sourcesElectronic databases, including PubMed, Embase, and Google Scholar.Study selectionProspective cohort studies were included if they reported adjusted relative risks, odds ratios, or hazard ratios and 95% confidence intervals for all cause mortality or cardiovascular outcomes in participants with unrecognised myocardial infarction compared with those without myocardial infarction.Data extraction and synthesisThe primary outcomes were composite major adverse cardiac events, all cause mortality, and cardiovascular mortality associated with UMI-ECG and UMI-CMR. The secondary outcomes were the risks of recurrent coronary heart disease or myocardial infarction, stroke, heart failure, and atrial fibrillation. Pooled hazard ratios and 95% confidence intervals were reported. The heterogeneity of outcomes was compared in clinically recognised and unrecognised myocardial infarction.ResultsThe meta-analysis included 30 studies with 253 425 participants and 1 621 920 person years of follow-up. UMI-ECG was associated with increased risks of all cause mortality (hazard ratio 1.50, 95% confidence interval 1.30 to 1.73), cardiovascular mortality (2.33, 1.66 to 3.27), and major adverse cardiac events (1.61, 1.38 to 1.89) compared with the absence of myocardial infarction. UMI-CMR was also associated with increased risks of all cause mortality (3.21, 1.43 to 7.23), cardiovascular mortality (10.79, 4.09 to 28.42), and major adverse cardiac events (3.23, 2.10 to 4.95). No major heterogeneity was observed for any primary outcomes between recognised myocardial infarction and UMI-ECG or UMI-CMR. The absolute risk differences were 7.50 (95% confidence interval 4.50 to 10.95) per 1000 person years for all cause mortality, 11.04 (5.48 to 18.84) for cardiovascular mortality, and 27.45 (17.1 to 40.05) for major adverse cardiac events in participants with UMI-ECG compared with those without myocardial infarction. The corresponding data for UMI-CMR were 32.49 (6.32 to 91.58), 37.2 (11.7 to 104.20), and 51.96 (25.63 to 92.04), respectively.ConclusionsUMI-ECG or UMI-CMR is associated with an adverse long term prognosis similar to that of recognised myocardial infarction. Screening for unrecognised myocardial infarction could be useful for risk stratification among patients with a high risk of cardiovascular disease.

show abstract

Prevalence and incidence of Q-wave unrecognized myocardial infarction in general population: Diagnostic value of the electrocardiogram. The REGICOR study

Cited by 11 publications

References 30 publications

Unrecognized myocardial infarction assessed by cardiac magnetic resonance imaging is associated with adverse long-term prognosis

Unrecognized myocardial infarction assessed by cardiac magnetic resonance imaging is associated with adverse long-term prognosis

General Practitioners’ Decision Making about Primary Prevention of Cardiovascular Disease in Older Adults: A Qualitative Study

Prognosis of unrecognised myocardial infarction determined by electrocardiography or cardiac magnetic resonance imaging: systematic review and meta-analysis

Contact Info

Product

Resources

About