de Torbal Anneke, Boersma Eric, Kors Jan A, van Herpen Gerard, Deckers Jaap W, van der Kuip Deirdre A M, Stricker Bruno H, Hofman Albert, Witteman Jacqueline C M
Department of Epidemiology and Biostatistics, Erasmus MC, PO Box 1738, 3000 DR Rotterdam, The Netherlands.
Eur Heart J. 2006 Mar;27(6):729-36. doi: 10.1093/eurheartj/ehi707. Epub 2006 Feb 14.
Contemporary data on the incidence of unrecognized myocardial infarction (MI) among subjects aged 55 and older are limited.
We studied the incidence of recognized and unrecognized MI in the Rotterdam Study, a population-based cohort of men and women aged 55 and older. The baseline examination was performed during 1990-93, with follow-up examinations during 1994-95, and 1997-2000. Baseline and follow-up 12-lead ECGs were analysed by the Modular ECG Analysis System. The 5148 participants who had no evidence of prevalent infarction were the subjects for analysis. Incident recognized infarction was defined as the occurrence of a fatal or non-fatal event coded as I21 according to the International Classification of Diseases, 10th edition. A repeat ECG was available in 4187 subjects. An unrecognized infarction was considered to have occurred if there was electrocardiographic evidence in the absence of a clinically recognized event. During a median follow-up of 6.4 years, 141 incident recognized infarctions occurred and the incidence rate of this event was 5.0 per 1000 person years. The incidence was higher in men (8.4) than in women (3.1). The incidence rate of unrecognized infarction was 3.8 per 1000 person years. Men (4.2) and women (3.6) had approximately similar incidence. Hence, the proportion of unrecognized infarction was lower in men (33%) than in women (54%). This difference in proportion of unrecognized infarctions was independent of age.
A high proportion of incident MIs remains clinically unrecognized. As a history of MI is associated with an increased risk of repeat cardiovascular complications, our data suggest a need for periodical electrocardiographic screening to recognize (prevalent) infarctions and to install effective preventive treatment in those aged 55 and older.
关于55岁及以上人群中未被识别的心肌梗死（MI）发病率的当代数据有限。
我们在鹿特丹研究中研究了已识别和未被识别的MI的发病率，该研究是一项基于人群的队列研究，对象为55岁及以上的男性和女性。基线检查在1990 - 1993年期间进行，随访检查在1994 - 1995年以及1997 - 2000年期间进行。基线和随访时的12导联心电图由模块化心电图分析系统进行分析。5148名无既往梗死证据的参与者作为分析对象。新发已识别梗死定义为根据国际疾病分类第10版编码为I21的致命或非致命事件的发生。4187名受试者有重复心电图。如果在没有临床识别事件的情况下有心电图证据，则认为发生了未被识别的梗死。在中位随访6.4年期间，发生了141例新发已识别梗死，该事件的发病率为每1000人年5.0例。男性的发病率（8.4）高于女性（3.1）。未被识别梗死的发病率为每1000人年3.8例。男性（4.2）和女性（3.6）的发病率大致相似。因此，未被识别梗死的比例在男性中（33%）低于女性（54%）。未被识别梗死比例的这种差异与年龄无关。
很大一部分新发心肌梗死在临床上仍未被识别。由于心肌梗死病史与再次发生心血管并发症的风险增加相关，我们的数据表明需要进行定期心电图筛查，以识别（既往）梗死，并对55岁及以上人群实施有效的预防性治疗。
