Department of Endocrinology-Diabetology-Nutrition, Paris-Nord University, Jean-Verdier Hospital, AP-HP, CNRH-IdF, avenue du 14-Juillet, 93143 Bondy cedex, France.
Arch Cardiovasc Dis. 2011 Mar;104(3):178-88. doi: 10.1016/j.acvd.2010.11.013. Epub 2011 Mar 26.
The prevalence, incidence, risk factors and prognosis of silent myocardial infarction are less well known than those of silent myocardial ischaemia. The aims of this article are to evaluate the prevalence and incidence of silent myocardial infarction in subjects with or without a history of cardiovascular disease and in diabetic patients, and to identify potential risk factors and estimate prognosis through a review of the literature. A Medline search identified studies that provided data on the prevalence, incidence, potential risk factors and/or prognosis of silent myocardial infarction, among cohorts from the general population and large clinical studies of at-risk patients (with hypertension or a history of cardiovascular disease or diabetes). The search identified 15 studies in subjects from the general population, five in hypertensive patients, six in patients with a history of cardiovascular disease, and 10 in diabetic patients. The prevalence and incidence of silent myocardial infarction appear highly variable depending on the population studied, the patients' ages, and the method used to detect silent myocardial infarction. In the general population, the prevalence of silent myocardial infarction increased markedly with increasing age (up to>5% in elderly subjects). Hypertension causes only a moderate increase in prevalence, whereas underlying cardiovascular diseases and diabetes are associated with marked increases in prevalence. The incidence of silent myocardial infarction changes in the same way. The main predictive factors of silent myocardial infarction are hypertension, history of cardiovascular diseases and diabetes duration. Silent myocardial infarction is associated with as poor a prognosis as clinical myocardial infarction. The frequency of silent myocardial infarction and the poor prognosis in at-risk patients amply justify its systematic early detection and active management.
无症状心肌梗死的患病率、发病率、危险因素和预后不如无症状心肌缺血那么为人熟知。本文的目的是评估有或无心血管疾病史和糖尿病患者中无症状心肌梗死的患病率和发病率，并通过文献复习确定潜在的危险因素和估计预后。通过 Medline 检索，我们找到了提供一般人群队列和高危患者（高血压或有心血管疾病史或糖尿病）大临床研究中无症状心肌梗死的患病率、发病率、潜在危险因素和/或预后数据的研究。该检索共识别出 15 项针对一般人群的研究、5 项针对高血压患者的研究、6 项针对有心血管疾病史的患者的研究以及 10 项针对糖尿病患者的研究。无症状心肌梗死的患病率和发病率因研究人群、患者年龄以及用于检测无症状心肌梗死的方法而异，差异很大。在一般人群中，无症状心肌梗死的患病率随年龄的增加而显著增加（在老年人群中高达>5%）。高血压仅导致患病率适度增加，而潜在的心血管疾病和糖尿病与患病率的显著增加有关。无症状心肌梗死的发病率也随之变化。无症状心肌梗死的主要预测因素是高血压、心血管疾病史和糖尿病病程。无症状心肌梗死与临床心肌梗死一样预后不良。高危患者中无症状心肌梗死的高频率和不良预后充分证明了其系统的早期检测和积极管理是合理的。
