Unrecognized Non-Q-Wave Myocardial Infarction: Prevalence and Prognostic Significance in Patients with Suspected Coronary Disease
Key result
Unrecognized non-Q-wave myocardial infarction identified by DE-CMR independently predicted an 11.4-fold increased risk of all-cause mortality compared to patients without myocardial infarction.
Why the study?
Does the presence of non-Q-wave unrecognized myocardial infarction identified by DE-CMR predict mortality in patients with suspected coronary disease?
Population
185 patients with suspected coronary disease and without history of clinical myocardial infarction who were…
Comparison
Identification of non-Q-wave unrecognized… vs Patients without myocardial infarction or with…
Design
Cohort
Follow-up
2.2 years (interquartile range 1.8-2.7)
Authors
Discussion
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Member takes
Implication
Supports DE-CMR for risk stratification in suspected CAD; leaves open whether detection improves outcomes or warrants routine screening.
Study Design
Type
Cohort (n=185)
Multicenter
Yes
Structured PICO
Does the presence of non-Q-wave unrecognized myocardial infarction identified by DE-CMR predict mortality in patients with suspected coronary disease?
P
Population
185 patients with suspected coronary disease and without history of clinical myocardial infarction who were scheduled for invasive coronary angiography.
I
Intervention
Identification of non-Q-wave unrecognized myocardial infarction (UMI) using delayed-enhancement cardiovascular magnetic resonance (DE-CMR)
C
Comparator
Patients without myocardial infarction or with Q-wave UMI identified by electrocardiography
O
Outcome
All-cause mortalityhard clinical
Main Result
Effect estimate: HR 11.4 (95% CI 2.5-51.1)
Absolute Event Rate: 26% vs 2%
p-value: p=0.002
In patients with suspected coronary disease, non-Q-wave unrecognized myocardial infarction identified by DE-CMR is common and strongly predicts all-cause and cardiac mortality independently of LVEF.
Limitations
- Small number of events in the study limited the ability to evaluate the incremental prognostic value of infarct size.
- Findings may not be applicable to entirely asymptomatic cohorts since many patients had symptoms like chest pain and dyspnea.
- Lack of data on the number of patients screened, declined, or excluded over the recruitment period.
Cite This Study
Kim et al. (2009) conducted a cohort in Suspected coronary disease (n=185). Presence of non-Q-wave unrecognized myocardial infarction (UMI) vs. Absence of myocardial infarction was evaluated on All-cause mortality (HR 11.4, 95% CI 2.5-51.1, p=0.002). Unrecognized non-Q-wave myocardial infarction identified by DE-CMR independently predicted an 11.4-fold increased risk of all-cause mortality compared to patients without myocardial infarction.