为了调查首次急性心肌梗死（AMI）患者中无症状心肌梗塞（MI）的患病率，以及其与长期随访中死亡率和主要不良心血管事件（MACE）的关系。在近400例心肌梗塞（MI）患者中，进行了晚期钆增强（LGE）的心脏磁共振成像（CMR），并且超过8％的人群显示先前无症状的MI。 这些患者的死亡率和主要不良心脏事件风险随后增加3-4倍。 因此，在患有临床MI的患者中，通过CMR与LGE鉴定沉默MI具有重要的预后意义，并且应该对这些患者进行积极的管理。
OBJECTIVES:This study investigated the prevalence of silent myocardial infarction (MI) in patients presenting with first acute myocardial infarction (AMI), and its relation with mortality and major adverse cardiovascular events (MACE) at long-term follow-up.
BACKGROUND:Up to 54% of MI occurs without apparent symptoms. The prevalence and long-term prognostic implications of previous silent MI in patients presenting with seemingly first AMI are unclear.
METHODS:A 2-center observational longitudinal study was performed in 392 patients presenting with first AMI between 2003 and 2013, who underwent late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) examination within 14 days post-AMI. Silent MI was assessed on LGE-CMR images by identifying regions of hyperenhancement with an ischemic distribution pattern in other territories than the AMI. Mortality and MACE (all-cause death, reinfarction, coronary artery bypass grafting, and ischemic stroke) were assessed at 6.8 ± 2.9 years follow-up.
RESULTS:Thirty-two patients (8.2%) showed silent MI on LGE-CMR. Compared with patients without silent MI, mortality risk was higher in patients with silent MI (hazard ratio: 3.87; 95% confidence interval: 1.21 to 12.38; p = 0.023), as was risk of MACE (hazard ratio: 3.10; 95% confidence interval: 1.22 to 7.86; p = 0.017), both independent from clinical and infarction-related characteristics.
CONCLUSIONS:Silent MI occurred in 8.2% of patients presenting with first AMI and was independently related to poorer long-term clinical outcome, with a more than 3-fold risk of mortality and MACE. Silent MI holds prognostic value over important traditional prognosticators in the setting of AMI, indicating that these patients represent a high-risk subgroup warranting clinical awareness.
