Department of Geriatrics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China.
Department of Cardiology, Shunde Hospital, Southern Medical University, Jiazhi Road 1, Lunjiao Town, Shunde District, Foshan, 528300, China.
BMJ. 2020 May 7;369:m1184. doi: 10.1136/bmj.m1184.
To evaluate the prognosis of unrecognised myocardial infarction determined by electrocardiography (UMI-ECG) or cardiac magnetic resonance imaging (UMI-CMR).
Systematic review and meta-analysis of prospective studies.
Electronic databases, including PubMed, Embase, and Google Scholar.
Prospective cohort studies were included if they reported adjusted relative risks, odds ratios, or hazard ratios and 95% confidence intervals for all cause mortality or cardiovascular outcomes in participants with unrecognised myocardial infarction compared with those without myocardial infarction.
The primary outcomes were composite major adverse cardiac events, all cause mortality, and cardiovascular mortality associated with UMI-ECG and UMI-CMR. The secondary outcomes were the risks of recurrent coronary heart disease or myocardial infarction, stroke, heart failure, and atrial fibrillation. Pooled hazard ratios and 95% confidence intervals were reported. The heterogeneity of outcomes was compared in clinically recognised and unrecognised myocardial infarction.
The meta-analysis included 30 studies with 253 425 participants and 1 621 920 person years of follow-up. UMI-ECG was associated with increased risks of all cause mortality (hazard ratio 1.50, 95% confidence interval 1.30 to 1.73), cardiovascular mortality (2.33, 1.66 to 3.27), and major adverse cardiac events (1.61, 1.38 to 1.89) compared with the absence of myocardial infarction. UMI-CMR was also associated with increased risks of all cause mortality (3.21, 1.43 to 7.23), cardiovascular mortality (10.79, 4.09 to 28.42), and major adverse cardiac events (3.23, 2.10 to 4.95). No major heterogeneity was observed for any primary outcomes between recognised myocardial infarction and UMI-ECG or UMI-CMR. The absolute risk differences were 7.50 (95% confidence interval 4.50 to 10.95) per 1000 person years for all cause mortality, 11.04 (5.48 to 18.84) for cardiovascular mortality, and 27.45 (17.1 to 40.05) for major adverse cardiac events in participants with UMI-ECG compared with those without myocardial infarction. The corresponding data for UMI-CMR were 32.49 (6.32 to 91.58), 37.2 (11.7 to 104.20), and 51.96 (25.63 to 92.04), respectively.
UMI-ECG or UMI-CMR is associated with an adverse long term prognosis similar to that of recognised myocardial infarction. Screening for unrecognised myocardial infarction could be useful for risk stratification among patients with a high risk of cardiovascular disease.
评估心电图（UMI-ECG）或心脏磁共振成像（UMI-CMR）检测到的未识别心肌梗死的预后。
前瞻性研究的系统评价和荟萃分析。
电子数据库，包括 PubMed、Embase 和 Google Scholar。
如果前瞻性队列研究报告了调整后的相对风险、优势比或风险比，以及参与者中与无心肌梗死相比，未识别心肌梗死与全因死亡率或心血管结局相关的 95%置信区间，则纳入研究。
主要结局是与 UMI-ECG 和 UMI-CMR 相关的复合主要不良心脏事件、全因死亡率和心血管死亡率。次要结局是复发性冠心病或心肌梗死、卒中和心力衰竭、心房颤动的风险。报告了合并风险比和 95%置信区间。在临床识别和未识别的心肌梗死中比较了结局的异质性。
荟萃分析纳入了 30 项研究，共 253425 名参与者和 1621920 人年随访。与无心肌梗死相比，UMI-ECG 与全因死亡率（风险比 1.50，95%置信区间 1.30 至 1.73）、心血管死亡率（2.33，1.66 至 3.27）和主要不良心脏事件（1.61，1.38 至 1.89）的风险增加相关。UMI-CMR 也与全因死亡率（3.21，1.43 至 7.23）、心血管死亡率（10.79，4.09 至 28.42）和主要不良心脏事件（3.23，2.10 至 4.95）的风险增加相关。在识别心肌梗死与 UMI-ECG 或 UMI-CMR 之间，任何主要结局均未观察到明显的异质性。UMI-ECG 组参与者的每 1000 人年全因死亡率绝对风险差异为 7.50（95%置信区间 4.50 至 10.95），心血管死亡率为 11.04（5.48 至 18.84），主要不良心脏事件为 27.45（17.1 至 40.05）。UMI-CMR 组的相应数据分别为 32.49（6.32 至 91.58）、37.2（11.7 至 104.20）和 51.96（25.63 至 92.04）。
UMI-ECG 或 UMI-CMR 与类似的识别心肌梗死的不良长期预后相关。对未识别心肌梗死的筛查可能有助于对心血管疾病风险较高的患者进行风险分层。
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