Prognostic implications of unrecognized myocardial infarction before elective percutaneous coronary intervention

Figure 1. Representative images of patients with unrecognized myocardial infarction. A 69-year-old man with a history of diabetes mellitus with stable coronary artery disease. (A) Short-axis view of delayed-enhancement cardiac magnetic resonance imaging with anterior late gadolinium enhancement (arrowheads). (B) Pre-PCI angiography showing significant coronary stenosis in the proximal left anterior descending artery. The FFR value was 0.53. (C) Post-PCI angiography demonstrating implantation of a drug-eluting coronary stent in the LAD lesion. The FFR value after PCI was 0.91. PCI percutaneous coronary intervention, FFR fractional flow reserve, LAD left anterior descending artery.

Figure 2. Association of FFR with the prevalence of unrecognized myocardial infarction. When patients were divided into tertiles based of FFR of culprit lesion stenosis, the frequency of UMI was significantly higher in the lower FFR group. FFR fractional flow reserve, UMI unrecognized myocardial infarction.

Figure 3. Kaplan–Meier analysis for the incidence of primary MACE according to the presence of UMI. The incidence of primary MACE was significantly higher in patients with UMI than that in those without UMI. Primary MACE was defined as cardiovascular death, nonfatal myocardial infarction, hospitalization for congestive heart failure, unplanned late revascularization and ischemic stroke. UMI unrecognized myocardial infarction, MACE major adverse cardiovascular events.