Section on Hospital Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
Section on Cardiovascular Medicine, Department of Medicine, WellSpan Health, York, Pennsylvania, USA.
Ann Noninvasive Electrocardiol. 2023 Sep;28(5):e13081. doi: 10.1111/anec.13081. Epub 2023 Aug 8.
Silent myocardial infarction (SMI) on electrocardiogram (ECG) is associated with atherosclerotic cardiovascular disease, but the relationship between SMI on ECG and coronary artery calcium (CAC) remains poorly understood.
Characterize the relationship between SMI on ECG and CAC.
Eligible participants from the Multi-Ethnic Study of Atherosclerosis study had ECG and CAC scoring at study enrollment (2000-2002). SMI was defined as ECG evidence of myocardial infarction in the absence of a history of clinical cardiovascular disease. CAC was modeled both continuously and categorically. The cross-sectional relationships between SMI on ECG and CAC were assessed using logistic regression and linear regression.
Among 6705 eligible participants, 178 (2.7%) had baseline SMI. Compared to participants without SMI, those with SMI had higher CAC (median [IQR]: 61.2 [0-261.7] vs. 0 [0-81.5]; p < .0001). Participants with SMI were more likely to have non-zero CAC (74% vs. 49%) and were more likely to have CAC ≥ 100 (40% vs. 23%). In a multivariable-adjusted logistic model, SMI was associated with higher odds of non-zero CAC (odds ratio 2.17, 95% CI 1.48-3.20, p < .0001) and 51% higher odds of CAC ≥ 100 (odds ratio 1.51, 95% CI 1.06-2.16, p = .02).
An incidental finding of SMI on ECG may serve to identify patients who have a higher odds of significant CAC and may benefit from additional risk stratification to further refine their cardiovascular risk. Further exploration of the utility of CAC assessment in this patient population is needed.
心电图（ECG）上的无症状性心肌梗死（SMI）与动脉粥样硬化性心血管疾病相关，但 ECG 上的 SMI 与冠状动脉钙（CAC）之间的关系仍知之甚少。
描述 ECG 上的 SMI 与 CAC 之间的关系。
多民族动脉粥样硬化研究中的合格参与者在研究入组时（2000-2002 年）进行了 ECG 和 CAC 评分。SMI 定义为无临床心血管疾病史的情况下心电图上心肌梗死的证据。CAC 连续和分类建模。使用逻辑回归和线性回归评估 ECG 上的 SMI 与 CAC 之间的横断面关系。
在 6705 名合格参与者中，有 178 名（2.7%）基线时存在 SMI。与无 SMI 的参与者相比，有 SMI 的参与者 CAC 更高（中位数 [IQR]：61.2 [0-261.7] 与 0 [0-81.5]；p < .0001）。有 SMI 的参与者更有可能 CAC 非零（74% 与 49%），更有可能 CAC≥100（40%与 23%）。在多变量调整后的逻辑模型中，SMI 与 CAC 非零的可能性增加相关（优势比 2.17，95%置信区间 1.48-3.20，p < .0001），且 CAC≥100 的可能性增加 51%（优势比 1.51，95%置信区间 1.06-2.16，p = .02）。
ECG 上偶然发现的 SMI 可能有助于识别 CAC 显著增加的患者，并且可能需要进一步的风险分层来进一步降低其心血管风险。需要进一步探索 CAC 评估在该患者群体中的应用。
