Prevalence, Extent, and Independent Predictors of Silent Myocardial Infarction
Prevalence, Extent, and Independent Predictors of Silent Myocardial Infarction
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DOI：
10.1016/j.amjmed.2012.11.028
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发表时间：
2013-06-01
影响因子：
5.9
通讯作者：
Zellweger, Michael J.
中科院分区：
文献类型：
--
作者：
Arenja, Nisha;Mueller, Christian;Zellweger, Michael J.
背景技术背景：无症状性心肌梗死的现象知之甚少。方法：我们的目的是评估无症状性心肌梗死的患病率，程度和独立的预测因素，在2个大的独立队列的连续患者没有心肌梗死的历史，参考静息/负荷心肌灌注单光子发射计算机断层扫描。有1621例患者入组推导队列，338例患者入组验证队列。无症状性心肌梗死的诊断标准为心肌瘢痕占左心室面积≥ 5%。结果：在推导队列中，无症状性心肌梗死的患病率为23.3%（n = 377）。中位梗死面积为左心室的10%（四分位距[IQR] 5%-15%）。糖尿病患者无症状心肌梗死的患病率为28.5%，非糖尿病患者为21.5%（P = 0.004）。糖尿病是无症状性心肌梗死的独立预测因素（比值比1.5; 95%可信区间，1.1-1.9; P = 0.004）。这些发现在独立验证队列中得到证实。在验证队列中，无症状心肌梗死的患病率为26.3%（n = 89），而糖尿病患者的患病率（35.8%）高于非糖尿病患者（24%; P = 0.049）。中位梗死面积为左心室的11.8%（IQR 5.9%-17.6%）。再次，在逻辑回归分析中，糖尿病是一个重要的无症状性心肌梗死的预测因素。结论：无症状性心肌梗死比以前认为的更常见。4例疑似冠状动脉疾病的患者中有1例发生了无症状心肌梗死;平均范围为左心室的10%，在糖尿病患者中更常见。(C)2013 Elsevier Inc. All rights reserved.
BACKGROUND: The phenomenon of silent myocardial infarction is poorly understood.METHODS: We aimed to evaluate the prevalence, extent, and independent predictors of silent myocardial infarction in 2 large independent cohorts of consecutive patients without a history of myocardial infarction referred for rest/stress myocardial perfusion single photon emission computed tomography. There were 1621 patients enrolled in the derivation cohort and 338 patients in the validation cohort. Silent myocardial infarction was diagnosed in patients with a myocardial scar >= 5% of the left ventricle.RESULTS: In the derivation cohort, the prevalence of silent myocardial infarction was 23.3% (n = 377). The median infarct size was 10% (interquartile range [IQR] 5%-15%) of the left ventricle. The prevalence of silent myocardial infarction was 28.5% in diabetics and 21.5% in nondiabetics (P = .004). Diabetes mellitus was an independent predictor for the presence of silent myocardial infarction (odds ratio 1.5; 95% confidence interval, 1.1-1.9; P = .004). These findings were confirmed in the independent validation cohort. In the validation cohort, the prevalence of silent myocardial infarction was 26.3% (n = 89), while the prevalence was higher in diabetics (35.8%) than in nondiabetics (24%; P = .049). The median infarct size was 11.8% (IQR 5.9%-17.6%) of the left ventricle. Again, in logistic regression analysis, diabetes mellitus was a significant predictor of the presence of silent myocardial infarction.CONCLUSION: Silent myocardial infarctions are more common than previously thought. One of 4 patients with suspected coronary artery disease had experienced a silent myocardial infarction; the extent in average is 10% of the left ventricle, and it is more common in diabetics. (C) 2013 Elsevier Inc. All rights reserved.