Silent MI Deadly

A population-based, prospective cohort study in Iceland revealed that the long-term mortality risk of unrecognized myocardial infarction (UMI) can be as high as clinically recognized myocardial infarction (RMI). 935 participants (aged 67-93 years, 48.3% men) were characterized with cardiac magnetic resonance (CMR) from January 2004 to January 2007 and followed up for up to 13.3 years. At 3 years, UMI and no MI mortality rates were similar (3%) and lower than RMI rates (9%). At 5 years, UMI mortality rates (13%) increased and were higher than no MI rates (8%) but still lower than RMI rates (19%). By 10 years, UMI and RMI mortality rates (49% and 51%, respectively) were not statistically different; both were significantly higher than no MI (30%). After adjusting for age, sex, and diabetes, UMI by CMR had an increased risk of death (hazard ratio [HR], 1.61), composite of major adverse cardiac events (MACE: death, nonfatal MI, and heart failure, HR, 1.56), MI (HR, 2.09), and heart failure (HR, 1.52) compared with no MI and statistically no different risk of death (HR, 0.99) and MACE (HR, 1.23) vs RMI. UMI by CMR is more prevalent than RMI in older populations. The study contributes to mounting evidence that UMI should be taken as seriously as any MI. Source: https://jamanetwork.com/