Prevalence and prognosis of unrecognized myocardial infarction determined by cardiac magnetic resonance in older adults.

• Published in: JAMA
• Main Authors: Schelbert, Erik B, Cao, Jie J, Sigurdsson, Sigurdur, Aspelund, Thor, Kellman, Peter, Aletras, Anthony H, Dyke, Christopher K, Thorgeirsson, Gudmundur, Eiriksdottir, Gudny, Launer, Lenore J, Gudnason, Vilmundur, Harris, Tamara B, Arai, Andrew E
• Other Authors: National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA.
• Format: Article in Journal/Newspaper
• Language: English
• Published: 2013
• Subjects: Aged; 80 and over; Atherosclerosis; Case-Control Studies; Cohort Studies; Diabetes Complications; Electrocardiography; Female; Humans; Iceland; Magnetic Resonance Imaging; Male; Myocardial Infarction; Prevalence; Prognosis; Risk; Ari
• Online Access: http://hdl.handle.net/2336/301417; https://doi.org/10.1001/2012.jama.11089

To access publisher's full text version of this article. Please click on the hyperlink in Additional Links field. Unrecognized myocardial infarction (MI) is prognostically important. Electrocardiography (ECG) has limited sensitivity for detecting unrecognized MI (UMI). Determine prevalence and mortality risk for UMI detected by cardiac magnetic resonance (CMR) imaging or ECG among older individuals. ICELAND MI is a cohort substudy of the Age, Gene/Environment Susceptibility-Reykjavik Study (enrollment January 2004-January 2007) using ECG or CMR to detect UMI. From a community-dwelling cohort of older individuals in Iceland, data for 936 participants aged 67 to 93 years were analyzed, including 670 who were randomly selected and 266 with diabetes. Prevalence and mortality of MI through September 1, 2011. Results reported with 95% confidence limits and net reclassification improvement (NRI). Of 936 participants, 91 had recognized MI (RMI) (9.7%; 95% CI, 8% to 12%), and 157 had UMI detected by CMR (17%; 95% CI, 14% to 19%), which was more prevalent than the 46 UMI detected by ECG (5%; 95% CI, 4% to 6%; P < .001). Participants with diabetes (n = 337) had more UMI detected by CMR than by ECG (n = 72; 21%; 95% CI, 17% to 26%, vs n = 15; 4%; 95% CI, 2% to 7%; P < .001). Unrecognized MI by CMR was associated with atherosclerosis risk factors, coronary calcium, coronary revascularization, and peripheral vascular disease. Over a median of 6.4 years, 30 of 91 participants (33%; 95% CI, 23% to 43%) with RMI died, and 44 of 157 participants (28%; 95% CI, 21% to 35%) with UMI died, both higher rates than the 119 of 688 participants (17%; 95% CI, 15% to 20%) with no MI who died. Unrecognized MI by CMR improved risk stratification for mortality over RMI (NRI, 0.34; 95% CI, 0.16 to 0.53). Adjusting for age, sex, diabetes, and RMI, UMI by CMR remained associated with mortality (hazard ratio [HR], 1.45; 95% CI, 1.02 to 2.06, absolute risk increase [ARI], 8%) and significantly improved risk stratification for mortality ...