CLINICAL STUDIES
Prevalence, predisposing factors, and prognosis of clinically unrecognized myocardial infarction in the elderly
Stuart E. Sheifer, MD*,
Bernard J. Gersh, MB, ChB, D.Phil, FACC ,
N. David Yanez, III, PhD ,
Philip A. Ades, MD, FACC ,
Gregory L. Burke, MD|| and
Teri A. Manolio, MD¶
* Division of Cardiology, Georgetown University Medical Center, Washington, DC, USA
Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
Division of Biostatistics, University of Washington, Seattle, Washington, USA
Division of Cardiology, University of Vermont, Burlington, Vermont, USA
|| Department of Public Health Sciences, Wake-Forest University School of Medicine, Winston-Salem, North Carolina, USA
¶ DECA—Cardiovascular Health Study, Bethesda, Maryland, USA
Manuscript received March 4, 1999;
revised manuscript received July 30, 1999,
accepted October 5, 1999.
Reprint requests and correspondence: Stuart E. Sheifer, Fellow, Division of Cardiology, Georgetown University Medical Center, 4 Main, 3800 Reservoir Road, N.W., Washington, DC 20007
sheifers{at}gusun.georgetown.edu
OBJECTIVES
This study was designed to determine the prevalence of unrecognized myocardial infarction (UMI), as well as risk factors, and to compare prognosis after detection of previously UMI to that after recognized myocardial infarction (RMI).
BACKGROUND
Past studies revealed that a significant proportion of MIs escape recognition, and that prognosis after such events is poor, but the epidemiology of UMI has not been reassessed in the contemporary era.
METHODS
The Cardiovascular Health Study (CHS) database, composed of individuals  65, was queried for participants who, at entry, demonstrated electrocardiographic evidence of a prior Q-wave MI, but who lacked a history of this diagnosis. The features and outcomes of this group were compared to those of individuals with prevalent RMI.
RESULTS
Of 5,888 participants, 901 evidenced a past MI, and 201 (22.3%) were previously unrecognized. The independent predictors of UMI were the absence of angina and the absence of congestive heart failure (CHF). Six-year mortality did not significantly differ between the two groups.
CONCLUSIONS
1) In the elderly, UMI continues to represent a significant proportion of all MIs; 2) associations with angina and CHF may reflect complex neurological issues, but they also may represent diagnosis bias; 3) these individuals can otherwise not be distinguished from those with recognized infarctions; and 4) mortality rates after UMI and RMI are similar. Future studies should address screening for UMI, risk stratification after detection of previously UMI, and the role of standard post-MI therapies.
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Abbreviations and Acronyms
| | CHF | = congestive heart failure | | CHS | = Cardiovascular Health Study | | CV | = cardiovascular | | DBP | = diastolic blood pressure | | FEV1 | = forced expiratory volume in 1 s by pulmonary function testing | | HTN | = hypertension | | MI | = myocardial infarction | | RMI | = recognized myocardial infarction | | SBP | = systolic blood pressure | | UMI | = unrecognized myocardial infarction |
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