Abstract
Background
Unrecognized myocardial infarction (MI) is a frequent condition with unknown underlying
reason. We hypothesized the lack of recognition of MI is related to pathophysiology,
specifically differences in underlying small and large vessel disease.
Methods
6128 participants were examined with retinal photography, ultrasound of the carotid
artery and a 12‑lead electrocardiography (ECG). Small vessel disease was defined as
narrower retinal arterioles and/or wider retinal venules measured on retinal photographs.
Large vessel disease was defined as carotid artery pathology. We defined unrecognized
MI as ECG-evidence of MI without a clinically recognized event. We analyzed the cross-sectional
relationship between MI recognition and markers of small and large vessel disease,
adjusted for age and sex.
Results
Unrecognized MI was present in 502 (8.2%) and recognized MI in 326 (5.3%) of the 6128
participants. Compared to recognized MI, unrecognized MI was associated with small
vessel disease indicated by narrower retinal arterioles (OR 1.66, 95% CI 1.05–2.62,
highest vs. lowest quartile). Unrecognized MI was less associated with wider retinal
venules (OR 0.55, 95% CI 0.35–0.87, lowest vs. highest quartile). Compared to recognized
MI, unrecognized MI was less associated with large vessel disease indicated by presence
of plaque in the carotid artery (OR for presence of carotid artery plaque in unrecognized
MI 0.51, 95% CI 0.37–0.69). No significant sex interaction was present.
Conclusions
Unrecognized MI was more associated with small vessel disease and less associated
with large vessel disease compared to recognized MI. These findings suggest that the
pathophysiology behind unrecognized and recognized MI may differ.
Keywords
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Article info
Publication history
Accepted:
October 2,
2017
Received in revised form:
September 28,
2017
Received:
June 6,
2017
Identification
Copyright
© 2017 Elsevier B.V. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Small and large vessels disease in unrecognized myocardial infarction: A long way to go?International Journal of CardiologyVol. 253
- PreviewA substantial proportion of myocardial infarctions (MIs) go unrecognized, often due to the lack of typical symptoms. “Silent”, “unrecognized” MI (UMIs) have been described in a variable but substantial percentage of the general population, with prevalence increasing by 10% per decade of age [1–3]. UMIs are associated with a similar or worse prognosis than “recognized” MIs (RMIs), risk of death and recurrent infarction being similar between ECG-detected unrecognized MI and recognized MI [1–3]. It is well known that in some patients MI may not be recognized, as it presents with atypical pain (e.g., women), or with different symptoms (e.g., dyspnea in elderly patients), or even entirely symptom-less (e.g., diabetics).
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