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Unrecognized myocardial infarction in subjects at high vascular risk: prevalence and determinants
  1. Matthijs F L Meijs (m.meijs{at}umcutrecht.nl)
  1. University Medical Center Utrecht, Netherlands
    1. Michiel L Bots (m.l.bots{at}umcutrecht.nl)
    1. University Medical Center Utrecht, Netherlands
      1. Maarten J Cramer (m.j.m.cramer{at}umcutrecht.nl)
      1. University Medical Center Utrecht, Netherlands
        1. Evert-Jan Vonken (e.vonken{at}umcutrecht.nl)
        1. University Medical Center Utrecht, Netherlands
          1. Birgitta K Velthuis (b.k.velthuis{at}umcutrecht.nl)
          1. University Medical Center Utrecht, Netherlands
            1. Yolanda van der Graaf (matthijsmeijs{at}gmail.com)
            1. University Medical Center Utrecht, Netherlands
              1. Frank L Visseren (f.l.visseren{at}umcutrecht.nl)
              1. University Medical Center Utrecht, Netherlands
                1. Willem P Mali (w.mali{at}umcutrecht.nl)
                1. University Medical Center Utrecht, Netherlands
                  1. Pieter Doevendans (p.doevendans{at}umcutrecht.nl)
                  1. University Medical Center Utrecht, Netherlands

                    Abstract

                    Objective: To investigate the prevalence and determinants of unrecognized myocardial infarction (UMI).

                    Design, setting, patients: In this cross-sectional study in a tertiary centre a delayed enhancement cardiac MRI (DE-CMR), which identifies both Q-wave and non-Q wave MIs, was performed in 502 subjects with manifest extra-cardiac atherosclerotic disease or marked risk factors for atherosclerosis without symptomatic coronary artery disease.

                    Main outcome measures: UMI was defined as the presence of delayed enhancement without corresponding clinical history.

                    Results: DE-CMR was of sufficient image quality in 480 (95.6%) subjects. An UMI was present in 45 (9.4%) of all subjects; in 13.1% of men and in 3.7% of women. The risk of UMI increased from 6.0% (95%CI 2.2-9.8%) in those with 2 vascular risk factors up to 26.2% (95%CI 15.2-37.3%) in those with 4 or 5 risk factors. In multivariable analysis the risk of UMI was related to male gender (OR 2.3 (95%CI 1.0-5.6)), age (OR 1.04 (95%CI 1.00-1.07) per year), ever smoking (OR 3.1 (95%CI 1.0-9.1), history of stroke (OR 1.9 (95%CI 0.8-4.3)) and history of aneurysm of the abdominal aorta (OR 2.6 (95%CI 1.0-6.9)).

                    Conclusions: In cardiac asymptomatic subjects at high vascular risk UMI is common. The risk of UMI increases with increasing presence of risk factors.

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