Comparison of prognosis in unrecognized versus recognized myocardial infarction in men versus women >55 years of age (from the Rotterdam Study).
Unrecognized myocardial infarction (MI) is frequent in the general population. Its prognosis is reported to be at least as unpropitious as that of recognized MI, particularly in men. However, contemporary data with long follow-up are lacking. The aims of this study were to investigate the long-term prognosis of unrecognized MI with respect to all-cause and cause-specific mortality and to investigate possible differences in prognosis by gender. In the population-based Rotterdam Study (2,672 men and 3,862 women), the presence of unrecognized MI and recognized MI was determined at baseline (1990 to 1993). The cohort was followed for nearly 2 decades for all-cause and cause-specific mortality. During 82,268 patient-years of follow-up (median 15.6 years) 3,412 patients died (1,300 from cardiovascular causes). Men and women with recognized and unrecognized MIs had increased total mortality rates compared with those without MIs. Hazard ratios (HRs) for men and women were 1.57 (95% confidence interval [CI] 1.36 to 1.81) and 1.89 (95% CI 1.56 to 2.30) for recognized MI and 1.72 (95% CI 1.43 to 2.07) and 1.36 (95% CI 1.14 to 1.61) for unrecognized MI. Unrecognized MI was associated with increased risks for cardiovascular mortality (men: HR 2.19, 95% CI 1.66 to 2.91; women: HR 1.36, 95% CI 1.03 to 1.81) and noncardiovascular mortality (men: HR 1.47, 95% CI 1.14 to 1.89; women: HR 1.39, 95% CI 1.10 to 1.75). In conclusion, the long-term prognosis of patients with unrecognized MIs is worse compared with those without MIs and applies not only to cardiovascular mortality but also to noncardiovascular mortality. In men, the prognosis is as unfavorable as that of patients with recognized MIs.
Department of Epidemiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands. Electronic address: a.dehghan@erasmusmc.nl.
Abbas
A
Dehghan
Department of Epidemiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Maarten J G
MJ
Leening
Department of Epidemiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Abbas M
AM
Solouki
Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Eric
E
Boersma
Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Jaap W
JW
Deckers
Department of Medical Informatics, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Gerard
G
van Herpen
Department of Epidemiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Jan
J
Heeringa
Department of Epidemiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Albert
A
Hofman
Department of Medical Informatics, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Jan A
JA
Kors
Department of Epidemiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Oscar H
OH
Franco
Department of Epidemiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Radiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Neurology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands.
M Arfan
MA
Ikram
Department of Epidemiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Jacqueline C M
JC
Witteman
D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology*; D009426:Netherlands / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D017678:Sex Distribution; D012737:Sex Factors; D015996:Survival Rate / Q000639:trends; D014505:Urban Population