Department of Cardiology, University Hospital Basel, Switzerland.
Am J Med. 2013 Jun;126(6):515-22. doi: 10.1016/j.amjmed.2012.11.028. Epub 2013 Apr 15.
The phenomenon of silent myocardial infarction is poorly understood.
We aimed to evaluate the prevalence, extent, and independent predictors of silent myocardial infarction in 2 large independent cohorts of consecutive patients without a history of myocardial infarction referred for rest/stress myocardial perfusion single photon emission computed tomography. There were 1621 patients enrolled in the derivation cohort and 338 patients in the validation cohort. Silent myocardial infarction was diagnosed in patients with a myocardial scar ≥5% of the left ventricle.
In the derivation cohort, the prevalence of silent myocardial infarction was 23.3% (n = 377). The median infarct size was 10% (interquartile range [IQR] 5%-15%) of the left ventricle. The prevalence of silent myocardial infarction was 28.5% in diabetics and 21.5% in nondiabetics (P = .004). Diabetes mellitus was an independent predictor for the presence of silent myocardial infarction (odds ratio 1.5; 95% confidence interval, 1.1-1.9; P = .004). These findings were confirmed in the independent validation cohort. In the validation cohort, the prevalence of silent myocardial infarction was 26.3% (n = 89), while the prevalence was higher in diabetics (35.8%) than in nondiabetics (24%; P = .049). The median infarct size was 11.8% (IQR 5.9%-17.6%) of the left ventricle. Again, in logistic regression analysis, diabetes mellitus was a significant predictor of the presence of silent myocardial infarction.
Silent myocardial infarctions are more common than previously thought. One of 4 patients with suspected coronary artery disease had experienced a silent myocardial infarction; the extent in average is 10% of the left ventricle, and it is more common in diabetics.
无症状心肌梗死现象尚未被充分理解。
我们旨在评估在两个大型连续无心梗病史的患者队列中，静息/负荷心肌灌注单光子发射计算机断层扫描的患病率、范围和独立预测因素。推导队列纳入了 1621 例患者，验证队列纳入了 338 例患者。无症状心肌梗死的诊断标准为心肌瘢痕≥左心室的 5%。
在推导队列中，无症状心肌梗死的患病率为 23.3%（n=377）。中位数梗死面积为左心室的 10%（四分位间距[IQR]为 5%-15%）。糖尿病患者的无症状心肌梗死患病率为 28.5%，非糖尿病患者为 21.5%（P=0.004）。糖尿病是无症状心肌梗死存在的独立预测因素（优势比 1.5；95%置信区间，1.1-1.9；P=0.004）。这些发现得到了独立验证队列的证实。在验证队列中，无症状心肌梗死的患病率为 26.3%（n=89），而糖尿病患者（35.8%）高于非糖尿病患者（24%）（P=0.049）。中位数梗死面积为左心室的 11.8%（IQR 5.9%-17.6%）。同样，在逻辑回归分析中，糖尿病是无症状心肌梗死存在的显著预测因素。
无症状心肌梗死比之前认为的更为常见。每 4 例疑似冠心病患者中就有 1 例曾发生无症状心肌梗死；平均梗死面积为左心室的 10%，且在糖尿病患者中更为常见。
