Long-Term Prognostic Implications of Previous Silent Myocardial Infarction in Patients Presenting With Acute Myocardial Infarction

Raquel P Amier, Martijn W Smulders, Wiesje M van der Flier, Sebastiaan C A M Bekkers, Alwin Zweerink, Cornelis P Allaart, Ahmet Demirkiran, Sebastiaan T Roos, Paul F A Teunissen, Yolande Appelman, Niels van Royen, Raymond J Kim, Albert C van Rossum, Robin Nijveldt

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

OBJECTIVES: This study investigated the prevalence of silent myocardial infarction (MI) in patients presenting with first acute myocardial infarction (AMI), and its relation with mortality and major adverse cardiovascular events (MACE) at long-term follow-up.

BACKGROUND: Up to 54% of MI occurs without apparent symptoms. The prevalence and long-term prognostic implications of previous silent MI in patients presenting with seemingly first AMI are unclear.

METHODS: A 2-center observational longitudinal study was performed in 392 patients presenting with first AMI between 2003 and 2013, who underwent late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) examination within 14 days post-AMI. Silent MI was assessed on LGE-CMR images by identifying regions of hyperenhancement with an ischemic distribution pattern in other territories than the AMI. Mortality and MACE (all-cause death, reinfarction, coronary artery bypass grafting, and ischemic stroke) were assessed at 6.8 ± 2.9 years follow-up.

RESULTS: Thirty-two patients (8.2%) showed silent MI on LGE-CMR. Compared with patients without silent MI, mortality risk was higher in patients with silent MI (hazard ratio: 3.87; 95% confidence interval: 1.21 to 12.38; p = 0.023), as was risk of MACE (hazard ratio: 3.10; 95% confidence interval: 1.22 to 7.86; p = 0.017), both independent from clinical and infarction-related characteristics.

CONCLUSIONS: Silent MI occurred in 8.2% of patients presenting with first AMI and was independently related to poorer long-term clinical outcome, with a more than 3-fold risk of mortality and MACE. Silent MI holds prognostic value over important traditional prognosticators in the setting of AMI, indicating that these patients represent a high-risk subgroup warranting clinical awareness.

LanguageEnglish
Pages1773-1781
Number of pages9
JournalJACC. Cardiovascular imaging
Volume11
Issue number12
Early online date13 Apr 2018
DOIs
Publication statusPublished - 1 Dec 2018

Cite this

@article{241d89f0a7d0419ebebebe2916ce2a76,
title = "Long-Term Prognostic Implications of Previous Silent Myocardial Infarction in Patients Presenting With Acute Myocardial Infarction",
abstract = "OBJECTIVES: This study investigated the prevalence of silent myocardial infarction (MI) in patients presenting with first acute myocardial infarction (AMI), and its relation with mortality and major adverse cardiovascular events (MACE) at long-term follow-up.BACKGROUND: Up to 54{\%} of MI occurs without apparent symptoms. The prevalence and long-term prognostic implications of previous silent MI in patients presenting with seemingly first AMI are unclear.METHODS: A 2-center observational longitudinal study was performed in 392 patients presenting with first AMI between 2003 and 2013, who underwent late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) examination within 14 days post-AMI. Silent MI was assessed on LGE-CMR images by identifying regions of hyperenhancement with an ischemic distribution pattern in other territories than the AMI. Mortality and MACE (all-cause death, reinfarction, coronary artery bypass grafting, and ischemic stroke) were assessed at 6.8 ± 2.9 years follow-up.RESULTS: Thirty-two patients (8.2{\%}) showed silent MI on LGE-CMR. Compared with patients without silent MI, mortality risk was higher in patients with silent MI (hazard ratio: 3.87; 95{\%} confidence interval: 1.21 to 12.38; p = 0.023), as was risk of MACE (hazard ratio: 3.10; 95{\%} confidence interval: 1.22 to 7.86; p = 0.017), both independent from clinical and infarction-related characteristics.CONCLUSIONS: Silent MI occurred in 8.2{\%} of patients presenting with first AMI and was independently related to poorer long-term clinical outcome, with a more than 3-fold risk of mortality and MACE. Silent MI holds prognostic value over important traditional prognosticators in the setting of AMI, indicating that these patients represent a high-risk subgroup warranting clinical awareness.",
author = "Amier, {Raquel P} and Smulders, {Martijn W} and {van der Flier}, {Wiesje M} and Bekkers, {Sebastiaan C A M} and Alwin Zweerink and Allaart, {Cornelis P} and Ahmet Demirkiran and Roos, {Sebastiaan T} and Teunissen, {Paul F A} and Yolande Appelman and {van Royen}, Niels and Kim, {Raymond J} and {van Rossum}, {Albert C} and Robin Nijveldt",
note = "Copyright {\circledC} 2018 The Authors. Published by Elsevier Inc. All rights reserved.",
year = "2018",
month = "12",
day = "1",
doi = "10.1016/j.jcmg.2018.02.009",
language = "English",
volume = "11",
pages = "1773--1781",
journal = "JACC. Cardiovascular imaging",
issn = "1876-7591",
number = "12",

}

Long-Term Prognostic Implications of Previous Silent Myocardial Infarction in Patients Presenting With Acute Myocardial Infarction. / Amier, Raquel P; Smulders, Martijn W; van der Flier, Wiesje M; Bekkers, Sebastiaan C A M; Zweerink, Alwin; Allaart, Cornelis P; Demirkiran, Ahmet; Roos, Sebastiaan T; Teunissen, Paul F A; Appelman, Yolande; van Royen, Niels; Kim, Raymond J; van Rossum, Albert C; Nijveldt, Robin.

In: JACC. Cardiovascular imaging, Vol. 11, No. 12, 01.12.2018, p. 1773-1781.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Long-Term Prognostic Implications of Previous Silent Myocardial Infarction in Patients Presenting With Acute Myocardial Infarction

AU - Amier, Raquel P

AU - Smulders, Martijn W

AU - van der Flier, Wiesje M

AU - Bekkers, Sebastiaan C A M

AU - Zweerink, Alwin

AU - Allaart, Cornelis P

AU - Demirkiran, Ahmet

AU - Roos, Sebastiaan T

AU - Teunissen, Paul F A

AU - Appelman, Yolande

AU - van Royen, Niels

AU - Kim, Raymond J

AU - van Rossum, Albert C

AU - Nijveldt, Robin

N1 - Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

PY - 2018/12/1

Y1 - 2018/12/1

N2 - OBJECTIVES: This study investigated the prevalence of silent myocardial infarction (MI) in patients presenting with first acute myocardial infarction (AMI), and its relation with mortality and major adverse cardiovascular events (MACE) at long-term follow-up.BACKGROUND: Up to 54% of MI occurs without apparent symptoms. The prevalence and long-term prognostic implications of previous silent MI in patients presenting with seemingly first AMI are unclear.METHODS: A 2-center observational longitudinal study was performed in 392 patients presenting with first AMI between 2003 and 2013, who underwent late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) examination within 14 days post-AMI. Silent MI was assessed on LGE-CMR images by identifying regions of hyperenhancement with an ischemic distribution pattern in other territories than the AMI. Mortality and MACE (all-cause death, reinfarction, coronary artery bypass grafting, and ischemic stroke) were assessed at 6.8 ± 2.9 years follow-up.RESULTS: Thirty-two patients (8.2%) showed silent MI on LGE-CMR. Compared with patients without silent MI, mortality risk was higher in patients with silent MI (hazard ratio: 3.87; 95% confidence interval: 1.21 to 12.38; p = 0.023), as was risk of MACE (hazard ratio: 3.10; 95% confidence interval: 1.22 to 7.86; p = 0.017), both independent from clinical and infarction-related characteristics.CONCLUSIONS: Silent MI occurred in 8.2% of patients presenting with first AMI and was independently related to poorer long-term clinical outcome, with a more than 3-fold risk of mortality and MACE. Silent MI holds prognostic value over important traditional prognosticators in the setting of AMI, indicating that these patients represent a high-risk subgroup warranting clinical awareness.

AB - OBJECTIVES: This study investigated the prevalence of silent myocardial infarction (MI) in patients presenting with first acute myocardial infarction (AMI), and its relation with mortality and major adverse cardiovascular events (MACE) at long-term follow-up.BACKGROUND: Up to 54% of MI occurs without apparent symptoms. The prevalence and long-term prognostic implications of previous silent MI in patients presenting with seemingly first AMI are unclear.METHODS: A 2-center observational longitudinal study was performed in 392 patients presenting with first AMI between 2003 and 2013, who underwent late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) examination within 14 days post-AMI. Silent MI was assessed on LGE-CMR images by identifying regions of hyperenhancement with an ischemic distribution pattern in other territories than the AMI. Mortality and MACE (all-cause death, reinfarction, coronary artery bypass grafting, and ischemic stroke) were assessed at 6.8 ± 2.9 years follow-up.RESULTS: Thirty-two patients (8.2%) showed silent MI on LGE-CMR. Compared with patients without silent MI, mortality risk was higher in patients with silent MI (hazard ratio: 3.87; 95% confidence interval: 1.21 to 12.38; p = 0.023), as was risk of MACE (hazard ratio: 3.10; 95% confidence interval: 1.22 to 7.86; p = 0.017), both independent from clinical and infarction-related characteristics.CONCLUSIONS: Silent MI occurred in 8.2% of patients presenting with first AMI and was independently related to poorer long-term clinical outcome, with a more than 3-fold risk of mortality and MACE. Silent MI holds prognostic value over important traditional prognosticators in the setting of AMI, indicating that these patients represent a high-risk subgroup warranting clinical awareness.

U2 - 10.1016/j.jcmg.2018.02.009

DO - 10.1016/j.jcmg.2018.02.009

M3 - Article

VL - 11

SP - 1773

EP - 1781

JO - JACC. Cardiovascular imaging

T2 - JACC. Cardiovascular imaging

JF - JACC. Cardiovascular imaging

SN - 1876-7591

IS - 12

ER -