Nordenskjöld Anna M, Hammar Per, Ahlström Håkan, Bjerner Tomas, Duvernoy Olov, Eggers Kai M, Fröbert Ole, Hadziosmanovic Nermin, Lindahl Bertil
Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden.
Department of Radiology, Västmanland Hospital Västerås, Västerås, Sweden.
PLoS One. 2016 Feb 17;11(2):e0148803. doi: 10.1371/journal.pone.0148803. eCollection 2016.
Clinically unrecognized myocardial infarctions (UMI) are not uncommon and may be associated with adverse outcome. The aims of this study were to determine the prognostic implication of UMI in patients with stable suspected coronary artery disease (CAD) and to investigate the associations of UMI with the presence of CAD.
In total 235 patients late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) imaging and coronary angiography were performed. For each patient with UMI, the stenosis grade of the coronary branch supplying the infarcted area was determined. UMIs were present in 25% of the patients and 67% of the UMIs were located in an area supplied by a coronary artery with a stenosis grade ≥70%. In an age- and gender-adjusted model, UMI independently predicted the primary endpoint (composite of death, myocardial infarction, resuscitated cardiac arrest, hospitalization for unstable angina pectoris or heart failure within 2 years of follow-up) with an odds ratio of 2.9; 95% confidence interval 1.1-7.9. However, this association was abrogated after adjustment for age and presence of significant coronary disease. There was no difference in the primary endpoint rates between UMI patients with or without a significant stenosis in the corresponding coronary artery.
The presence of UMI was associated with a threefold increased risk of adverse events during follow up. However, the difference was no longer statistically significant after adjustments for age and severity of CAD. Thus, the results do not support that patients with suspicion of CAD should be routinely investigated by LGE-CMR for UMI. However, coronary angiography should be considered in patients with UMI detected by LGE-CMR.
ClinicalTrials.gov NTC01257282.
临床未识别的心肌梗死（UMI）并不罕见，且可能与不良预后相关。本研究的目的是确定UMI在稳定型疑似冠状动脉疾病（CAD）患者中的预后意义，并研究UMI与CAD存在之间的关联。
总共对235例患者进行了延迟钆增强心血管磁共振（LGE-CMR）成像和冠状动脉造影。对于每例UMI患者，确定供应梗死区域的冠状动脉分支的狭窄程度。25%的患者存在UMI，67%的UMI位于狭窄程度≥70%的冠状动脉所供应的区域。在年龄和性别调整模型中，UMI独立预测主要终点（随访2年内死亡、心肌梗死、心脏复苏骤停、因不稳定型心绞痛或心力衰竭住院的复合终点），比值比为2.9；95%置信区间为1.1-7.9。然而，在调整年龄和显著冠状动脉疾病的存在后，这种关联被消除。相应冠状动脉有无明显狭窄的UMI患者之间的主要终点发生率没有差异。
UMI的存在与随访期间不良事件风险增加三倍相关。然而，在调整年龄和CAD严重程度后，差异不再具有统计学意义。因此，结果不支持对疑似CAD患者常规进行LGE-CMR检查以筛查UMI。然而，对于通过LGE-CMR检测到UMI的患者，应考虑进行冠状动脉造影。
ClinicalTrials.gov NTC01257282。
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