title: Unrecognized Myocardial Infarction Assessed by Cardiac Magnetic Resonance Imaging--Prognostic Implications.
abstract: BACKGROUND
  Clinically unrecognized myocardial infarctions (UMI) are not uncommon and may be associated with adverse outcome. The aims of this study were to determine the prognostic implication of UMI in patients with stable suspected coronary artery disease (CAD) and to investigate the associations of UMI with the presence of CAD.
  
  
  RESULTS
  In total 235 patients late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) imaging and coronary angiography were performed. For each patient with UMI, the stenosis grade of the coronary branch supplying the infarcted area was determined. UMIs were present in 25% of the patients and 67% of the UMIs were located in an area supplied by a coronary artery with a stenosis grade ≥70%. In an age- and gender-adjusted model, UMI independently predicted the primary endpoint (composite of death, myocardial infarction, resuscitated cardiac arrest, hospitalization for unstable angina pectoris or heart failure within 2 years of follow-up) with an odds ratio of 2.9; 95% confidence interval 1.1-7.9. However, this association was abrogated after adjustment for age and presence of significant coronary disease. There was no difference in the primary endpoint rates between UMI patients with or without a significant stenosis in the corresponding coronary artery.
  
  
  CONCLUSIONS
  The presence of UMI was associated with a threefold increased risk of adverse events during follow up. However, the difference was no longer statistically significant after adjustments for age and severity of CAD. Thus, the results do not support that patients with suspicion of CAD should be routinely investigated by LGE-CMR for UMI. However, coronary angiography should be considered in patients with UMI detected by LGE-CMR.
  
  
  BACKGROUND
  ClinicalTrials.gov NTC01257282.
authors.affiliation: Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Nordenskjöld
authors.affiliation: Department of Radiology, Västmanland Hospital Västerås, Västerås, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Hammar
authors.affiliation: Department of Radiology, Oncology and Radiation Science, Uppsala University, Uppsala, Sweden.
authors.forename: Håkan
authors.initials: H
authors.lastname: Ahlström
authors.affiliation: Department of Radiology, Oncology and Radiation Science, Uppsala University, Uppsala, Sweden.
authors.forename: Tomas
authors.initials: T
authors.lastname: Bjerner
authors.affiliation: Department of Radiology, Oncology and Radiation Science, Uppsala University, Uppsala, Sweden.
authors.forename: Olov
authors.initials: O
authors.lastname: Duvernoy
authors.affiliation: Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.
authors.forename: Kai M
authors.initials: KM
authors.lastname: Eggers
authors.affiliation: Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden.
authors.forename: Ole
authors.initials: O
authors.lastname: Fröbert
authors.affiliation: Uppsala Clinical Research Centre, Uppsala, Sweden.
authors.forename: Nermin
authors.initials: N
authors.lastname: Hadziosmanovic
authors.affiliation: Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.
authors.forename: Bertil
authors.initials: B
authors.lastname: Lindahl
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000150:complications; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis*; D015995:Prevalence; D011379:Prognosis