Key result
Painless MI in the elderly is linked to a ~43% lower correct clinical diagnosis rate.
Why the study?
The diagnosis of silent myocardial ischemia in the aged remains controversial and requires evaluation of its basic state.
Observational (n=972)
Absolute Event Rate: 51% vs 89%
A significant proportion of elderly patients have silent myocardial ischemia and unrecognized myocardial infarctions, highlighting the challenge of diagnosing ischemic heart disease in this population.
Silent ischemia may be underrecognized in elderly CAD; leaves open prospective validation of screening strategies.
The diagnosis of silent myocardial ischemia in the aged remains controversial. In this study to evaluate the basic state of silent ischemia in the aged, a total of 972 consecutive autopsy cases (mean 79.0 yrs of age) were analyzed in terms of coronary atherosclerotic diseases. The following results were obtained: (1) Severe coronary occlusive lesions simultaneously detected in the three major coronary arterial branches were found in 85 cases (8.7%), of which 10 (12%) had neither history of angina nor myocardial infarction (MI), which may correspond to one representation of silent ischemia. (2) There were 218 cases of MI (22.4%), of which 106 (49%) were never documented to have MI during life. The latter may correspond to unrecognized MI. It was considered to be caused by 1) small or middle-sized MI in 66 cases and 2) lateral or nontransmural MI in 29 out of 40 large MI cases (more than 4.9 cm in diameter). (3) 30 cases (54%) out of 56 fresh and large MI with a correct diagnosis revealed no chest pain. This is an incidence of painless MI in the aged. This painless group showed a significant difference in the incidence of a correct diagnosis of MI (51% vs 89%), combined arrhythmia (47% vs 79%) and the association of CVD (47% vs 11%) compared with chest pain group.
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Ohkawa et al. (1989) conducted an observational in Silent myocardial ischemia (n=972). Painless myocardial infarction vs. Myocardial infarction with chest pain was evaluated on Correct diagnosis of MI. Painless myocardial infarction in the aged was associated with a significantly lower rate of correct clinical diagnosis (51% vs 89%) compared to MI with chest pain.
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