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Unrecognized MI confers similar long-term results to recognized MI
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Approximately two-thirds of MI diagnoses were missed by standard medical testing, and over time, outcomes were poor for patients with either unrecognized or recognized MI, according to the results of the ICELAND MI study presented at CMR 2018.
Unrecognized MI, defined as MI missed in routine medical care but detected by ECG or cardiac MRI, and recognized MI confer the same long-term risk for death, but undiagnosed patients do not receive appropriate amounts of medication to reduce mortality risk and other adverse outcomes compared with patients with known MI, according to a press release from the European Society of Cardiology.
“Unrecognized MI has a poor short-term prognosis, but until now, the long-term outlook was unknown,” Tushar Acharya, MD, cardiologist at the NHLBI, said in the release.
Acharya and colleagues enrolled 935 patients with a mean age of 76 years, 10% of whom had recognized MI and 17% with unrecognized MI at baseline.
After the researchers adjusted for age, sex and diabetes, they found that unrecognized MI as determined by cardiac MRI was independently associated with increased risk for death (HR = 1.6; 95% CI, 1.26-2.02), recurrent MI (HR = 2.05; 95% CI, 1.42-2.96), and HF (HR = 1.51; 95% CI, 1.07-2.11).
The mortality rate at 3 years was 3% in patients with undiagnosed MI, 3% in patients with no MI and 9% in patients with recognized MI.
At 5 years, mortality rates were 13% for unrecognized MI, 8% for no MI and 19% for recognized MI.
By 10 years, mortality rates in patients with unrecognized MI and recognized MI were 49% and 51% respectively, both of which were significantly higher than in patients with no MI (30%; P < .001).
Rates of recurrent MI at 10 years were 30% in unrecognized MI, 13% in no MI and 45% in recognized MI, while rates of HF at 10 years were 33% in unrecognized MI, 19% in no MI and 48% in recognized MI (P < .001 for both), according to the researchers.
“Using CMR in patients with cardiac symptoms would likely detect many more heart attacks than traditional diagnostic tests,” Acharya said in the release. “There are good therapies to treat survivors of MI so finding them early should improve prognosis.”– by Dave Quaile
Reference:
Acharya T, et al. CMR in Acute Coronary Syndromes. Presented at: CMR 2018; Jan. 31-Feb. 3; Barcelona, Spain.
Disclosure: The authors report no relevant financial disclosures.