title: Long-term prognosis of unrecognized myocardial infarction detected with cardiovascular magnetic resonance in an elderly population.
abstract: Individuals with unrecognized myocardial infarctions (UMIs) detected with cardiovascular magnetic resonance (CMR) constitute a recently defined group whose prognosis has not been fully evaluated. However, increasing evidence indicate that these individuals may be at considerable cardiovascular risk. The aim of the present study was to investigate the prognostic impact of CMR detected UMIs for major adverse cardiac events (MACE) in community living elderly individuals.
  
  
  
  Late gadolinium enhancement CMR was performed in 248 randomly chosen 70-year-olds. Individuals with myocardial infarction (MI) scars, with or without a hospital diagnosis of MI were classified as recognized MI (RMI) or UMI, respectively. Medical records and death certificates were scrutinized. MACE was defined as cardiac death, non-fatal MI, a new diagnosis of angina pectoris, or symptom-driven coronary artery revascularization.
  
  
  
  During follow-up (mean 11 years) MACE occurred in 10 % (n = 18/182) of the individuals without MI scars, in 20 % (n = 11/55) of the individuals with UMI, and in 45 % (n = 5/11) of the individuals with RMI, with a significant difference between the UMI group and the group without MI scars (p = 0.045), and between the RMI group and the group without MI scars (p = 0.0004). Cardiac death and/or non-fatal MI occurred in 15, 5, and 3 of the individuals in the NoMI, UMI, and RMI group respectively. Hazards ratios for MACE adjusted for risk factors and sex were 2.55 (95 % CI 1.20-5.42; p = 0.015) for UMI and 3.28 (95 % CI1.16-9.22; p = 0.025) for RMI.
  
  
  
  The presence of a CMR detected UMI entailed a more than double risk for MACE in community living 70-year-old individuals.
authors.affiliation: Department of Radiology, Uppsala University Hospital, Uppsala, 751 85, Sweden. Charlotte.Ebeling_Barbier@radiol.uu.se.
authors.forename: Charlotte Ebeling
authors.initials: CE
authors.lastname: Barbier
authors.affiliation: Department of Radiology, Uppsala University Hospital, Uppsala, 751 85, Sweden.
authors.forename: Raquel
authors.initials: R
authors.lastname: Themudo
authors.affiliation: Department of Radiology, Uppsala University Hospital, Uppsala, 751 85, Sweden.
authors.forename: Tomas
authors.initials: T
authors.lastname: Bjerner
authors.affiliation: Department of Radiology, Uppsala University Hospital, Uppsala, 751 85, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Johansson
authors.affiliation: Department of Medicine, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Lind
authors.affiliation: Department of Radiology, Uppsala University Hospital, Uppsala, 751 85, Sweden.
authors.forename: Håkan
authors.initials: H
authors.lastname: Ahlström
mesh_terms: D000367:Age Factors; D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis; D002423:Cause of Death; D003287:Contrast Media / Q000008:administration & dosage; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D019786:Gadolinium DTPA / Q000008:administration & dosage; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D009204:Myocardial Revascularization; D009206:Myocardium / Q000473:pathology*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors
chemical_list: D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA
keywords: Cardiovascular magnetic resonance; Epidemiology; Prognosis; Unrecognized myocardial infarction