title: Unrecognised myocardial infarction in subjects at high vascular risk: prevalence and determinants.
abstract: OBJECTIVE
  To investigate the prevalence and determinants of unrecognised myocardial infarction (UMI).
  
  
  METHODS
  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 extracardiac atherosclerotic disease or marked risk factors for atherosclerosis without symptomatic coronary artery disease.
  
  
  METHODS
  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. A 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 to 9.8%) in those with two vascular risk factors up to 26.2% (95% CI 15.2 to 37.3%) in those with four or five risk factors. In a multivariable analysis, the risk of UMI was related to male gender (OR 2.3 (95% CI 1.0 to 5.6)), age (OR 1.04 (95% CI 1.00 to 1.07) per year), ever smoking (OR 3.1 (95% CI 1.0 to 9.1), history of stroke (OR 1.9 (95% CI 0.8 to 4.3)) and history of aneurysm of the abdominal aorta (OR 2.6 (95% CI 1.0 to 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.
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, Utrecht 3584 CX, The Netherlands.
authors.forename: M F L
authors.initials: MF
authors.lastname: Meijs
authors.forename: M L
authors.initials: ML
authors.lastname: Bots
authors.forename: M J M
authors.initials: MJ
authors.lastname: Cramer
authors.forename: E-J A
authors.initials: EJ
authors.lastname: Vonken
authors.forename: B K
authors.initials: BK
authors.lastname: Velthuis
authors.forename: Y
authors.initials: Y
authors.lastname: van der Graaf
authors.forename: F L
authors.initials: FL
authors.lastname: Visseren
authors.forename: W P Th M
authors.initials: WP
authors.lastname: Mali
authors.forename: P A
authors.initials: PA
authors.lastname: Doevendans
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000627:therapeutic use; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005260:Female; D005682:Gadolinium / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000150:complications*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D015995:Prevalence; D011379:Prognosis; D018570:Risk Assessment; D012737:Sex Factors; D055815:Young Adult
chemical_list: D003287:Contrast Media; D005682:Gadolinium