title: Prevalence, predisposing factors, and prognosis of clinically unrecognized myocardial infarction in the elderly.
abstract: OBJECTIVE
  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 > or =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.
authors.affiliation: Division of Cardiology, Georgetown University Medical Center, Washington, DC 20007, USA. sheifers@gusun.georgetown.edu
authors.forename: S E
authors.initials: SE
authors.lastname: Sheifer
authors.forename: B J
authors.initials: BJ
authors.lastname: Gersh
authors.forename: N D
authors.initials: ND
authors.lastname: Yanez
authors.forename: P A
authors.initials: PA
authors.lastname: Ades
authors.forename: G L
authors.initials: GL
authors.lastname: Burke
authors.forename: T A
authors.initials: TA
authors.lastname: Manolio
mesh_terms: D000368:Aged; D002423:Cause of Death; D003327:Coronary Disease / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D011379:Prognosis; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D015996:Survival Rate