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Unrecognized myocardial infarction assessed by cardiac magnetic resonance imaging is associated with adverse long-term prognosis
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiology.
Department of Radiology, Oncology and Radiation Science, Uppsala University, Uppsala, Sweden.
Department of Radiology, Oncology and Radiation Science, Uppsala University, Uppsala, Sweden.
Department of Radiology, Oncology and Radiation Science, Uppsala University, Uppsala, Sweden.
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2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 7, article id e0200381Article in journal (Refereed) Published
Abstract [en]

Background: Unrecognized myocardial infarctions (UMIs) are common. The study is an extension of a previous study, aiming to investigate the long-term (>5 year) prognostic implication of late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) detected UMI in patients with suspected stable coronary artery disease (CAD) without previously diagnosed myocardial infarction (MI).

Methods: In 235 patients with suspected stable CAD without previous MI, LGE-CMR imaging and coronary angiography were performed. LGE with a subendocardial component detectable in more than one imaging plane was required to indicate UMI. The stenosis grade of the coronary arteries was determined, including in the artery supplying an infarcted area. Stenosis >= 70% stenosis was considered significant. Patients were followed for 5.4 years in mean regarding a composite endpoint of cardiovascular death, MI, hospitalization due to heart failure, stable or unstable angina.

Results: UMI were present in 58 of 235 patients (25%). Thirty-nine of the UMIs were located downstream of a significant coronary stenosis. During the follow-up 40 patients (17.0%) reached the composite endpoint. Of patients with UMI, 34.5% (20/58) reached the primary endpoint compared to 11.3% (20/177) of patients with no UMI (HR 3.7, 95% CI 2.0 +/- 6.9, p<0.001). The association between UMI and outcome remained (HR 2.3, 95% CI 1.2 +/- 4.4, p = 0.012) after adjustments for age, gender, extent of CAD and all other variables univariate associated with outcome. Sixteen (41%) of the patients with an UMI downstream of a significant stenosis reached the endpoint compared to four (21%) patients with UMI and no relation to a significant stenosis (HR 2.4, 95% CI 0.8 +/- 7.2, p = 0.12).

Conclusion: The presence of UMI was independently associated with an increased risk of cardiovascular events during long-term follow up.

Place, publisher, year, edition, pages
Public Library of Science , 2018. Vol. 13, no 7, article id e0200381
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:oru:diva-68777DOI: 10.1371/journal.pone.0200381ISI: 000437809500104PubMedID: 29979788Scopus ID: 2-s2.0-85049517694OAI: oai:DiVA.org:oru-68777DiVA, id: diva2:1245945
Funder
Swedish Research CouncilSwedish Heart Lung Foundation
Note

Funding Agencies:

Regional Research Council, Uppsala-Örebro region  RFR-84261 

Center for Clinical Research in Västmanland, from Bayer Pharmaceuticals Sweden 

Available from: 2018-09-06 Created: 2018-09-06 Last updated: 2018-09-06Bibliographically approved

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Nordenskjöld, Anna M.

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