Prevalence, predisposing factors, and prognosis of clinically unrecognized myocardial infarction in the elderly
Prevalence, predisposing factors, and prognosis of clinically unrecognized myocardial infarction in the elderly
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DOI：
10.1016/s0735-1097(99)00524-0
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发表时间：
2000-01-01
影响因子：
24
通讯作者：
Manolio, TA
中科院分区：
文献类型：
--
作者：
Sheifer, SE;Gersh, BJ;Manolio, TA
本研究旨在确定未被识别的心肌梗死（UMI）的患病率以及危险因素，并比较先前检测到的UMI与识别出的心肌梗死（RMI）后的预后。背景过去的研究表明，很大比例的MI无法识别，并且此类事件后的预后很差，但UMI的流行病学在当代尚未被重新评估。心血管健康研究（CHS）数据库由大于或等于65岁的个体组成，查询入组时心电图显示既往Q波MI证据但缺乏该诊断史的受试者。这组的功能和结果进行了比较的个人与流行RMI.RESULTS 5,888参与者，901证明了过去的MI，201（22.3%）以前未被识别。UMI的独立预测因素是无心绞痛和无充血性心力衰竭（CHF）。6年死亡率在两组之间没有显著差异。结论1）在老年人中，UMI继续代表所有MI的显著比例; 2）与心绞痛和CHF的关联可能反映了复杂的神经问题，但它们也可能代表诊断偏倚; 3）这些个体不能以其他方式与已识别的梗死区分开;（4）UMI和RMI后的死亡率相似。未来的研究应该解决UMI的筛查，检测到以前的UMI后的风险分层，以及标准的MT后治疗的作用。(C)1999年由美国心脏病学会。
OBJECTIVES This study was designed to determine the prevalence of unrecognized myocardial infarction (UMI), as well as risk factors, and to compare prognosis alter 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. The Cardiovascular Health Study (CHS) database, composed of individuals greater than or equal to 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-MT therapies. (C) 1999 by the American College of Cardiology.