Unrecognized myocardial infarction detected by LGE-CMR was associated with an increased risk of adverse cardiovascular events (OR 3.4), but this association was no longer statistically significant after adjusting for age and severity of coronary artery disease.
Cohort (n=235)
Yes
Does the presence of unrecognized myocardial infarction detected by LGE-CMR predict adverse outcomes in patients with stable suspected CAD?
Unrecognized myocardial infarction detected by LGE-CMR is associated with an increased risk of adverse events in stable CAD, but this risk is primarily driven by the severity of underlying coronary artery disease.
Effect estimate: OR 3.4 (95% CI 1.3-9.1)
Absolute Event Rate: 15.5% vs 5.1%
p-value: p=0.014
BACKGROUND: Clinically unrecognized myocardial infarctions (UMI) are not uncommon and may be associated with adverse outcome. The aims of this study were to determine the prognostic implication of UMI in patients with stable suspected coronary artery disease (CAD) and to investigate the associations of UMI with the presence of CAD. METHODS AND FINDINGS: In total 235 patients late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) imaging and coronary angiography were performed. For each patient with UMI, the stenosis grade of the coronary branch supplying the infarcted area was determined. UMIs were present in 25% of the patients and 67% of the UMIs were located in an area supplied by a coronary artery with a stenosis grade ≥70%. In an age- and gender-adjusted model, UMI independently predicted the primary endpoint (composite of death, myocardial infarction, resuscitated cardiac arrest, hospitalization for unstable angina pectoris or heart failure within 2 years of follow-up) with an odds ratio of 2.9; 95% confidence interval 1.1-7.9. However, this association was abrogated after adjustment for age and presence of significant coronary disease. There was no difference in the primary endpoint rates between UMI patients with or without a significant stenosis in the corresponding coronary artery. CONCLUSIONS: The presence of UMI was associated with a threefold increased risk of adverse events during follow up. However, the difference was no longer statistically significant after adjustments for age and severity of CAD. Thus, the results do not support that patients with suspicion of CAD should be routinely investigated by LGE-CMR for UMI. However, coronary angiography should be considered in patients with UMI detected by LGE-CMR. TRIAL REGISTRATION: ClinicalTrials.gov NTC01257282.
Nordenskjöld et al. (Wed,) conducted a cohort in Stable suspected coronary artery disease (n=235). Unrecognized Myocardial Infarction (UMI) detected by LGE-CMR vs. No Unrecognized Myocardial Infarction was evaluated on Composite of death, resuscitated cardiac arrest, myocardial infarction, and hospitalisation for congestive heart failure or unstable angina at 2 years (OR 3.4, 95% CI 1.3-9.1, p=0.014). Unrecognized myocardial infarction detected by LGE-CMR was associated with an increased risk of adverse cardiovascular events (OR 3.4), but this association was no longer statistically significant after adjusting for age and severity of coronary artery disease.