Rafel Ramos1, Xavier Albert2, Joan Sala3, Maria Garcia-Gil4, Roberto Elosua5, Jaume Marrugat5, Anna Ponjoan6, María Grau5, Manel Morales7, Antoni Rubió8, Pedro Ortuño9, Lia Alves-Cabratosa6, Ruth Martí-Lluch6. 1. ISV Research Group, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; Department of Medical Sciences, School of Medicine, University of Girona, Spain; Girona Biomedical Research Institute (IDIBGI), Catalan Institute of Health (ICS), Girona, Spain. Electronic address: rramos.girona.ics@gencat.cat. 2. Department of Medical Sciences, School of Medicine, University of Girona, Spain; Coronary Unit and Cardiology, Hospital Josep Trueta, Girona, Biomedical Research Institute, Girona (IdIBGi), ICS, Catalunya, Spain; Doctoral Program in Public Health and Biomedical Research Methods, Autonomous University of Barcelona, Spain. 3. Department of Medical Sciences, School of Medicine, University of Girona, Spain; Coronary Unit and Cardiology, Hospital Josep Trueta, Girona, Biomedical Research Institute, Girona (IdIBGi), ICS, Catalunya, Spain. 4. ISV Research Group, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; Department of Medical Sciences, School of Medicine, University of Girona, Spain; Girona Biomedical Research Institute (IDIBGI), Catalan Institute of Health (ICS), Girona, Spain. 5. Registre Gironí del COR (REGICOR) Group, Cardiovascular, Epidemiology and Genetics Research Group (EGEC), Municipal Institute for Medical Research (IMIM), Barcelona, Spain. 6. ISV Research Group, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; Girona Biomedical Research Institute (IDIBGI), Catalan Institute of Health (ICS), Girona, Spain. 7. Coronary Unit and Cardiology, Hospital Josep Trueta, Girona, Biomedical Research Institute, Girona (IdIBGi), ICS, Catalunya, Spain. 8. Department of Nuclear Medicine, Hospital Josep Trueta, Girona, Biomedical Research Institute, Girona (IdIBGi), ICS, Catalunya, Spain. 9. Department of Diagnostic Radiology, Hospital Josep Trueta, Girona, Biomedical Research Institute, Girona (IdIBGi), ICS, Catalunya, Spain.
Abstract
BACKGROUND: Diagnosis of unrecognized myocardial infarction (UMI) remains an open question in epidemiological and clinical studies, inhibiting effective secondary prevention of myocardial infarction. We aimed to determine the prevalence and incidence of Q-wave UMI in asymptomatic individuals aged 35 to 74years, and to ascertain the positive predictive value (PPV) of asymptomatic Q-wave to diagnose UMI. METHODS: Two population-based cross-sectional studies were conducted, in 2000 (with 10-year follow-up) and in 2005. A baseline electrocardiogram was obtained for each participant. Imaging techniques (echocardiography, cardiac magnetic resonance imaging, and myocardial perfusion single-photon emission computerized tomography) were used to confirm UMI in patients with asymptomatic Q-wave. RESULTS: The prevalence of confirmed Q-wave UMI in the 5580 participants was 0.18% (95% confidence interval [CI]: 0.10-0.33) and the incidence rate was 27.1 Q-wave UMI per 100,000person-years. The proportion of confirmed Q-wave UMI with respect to all prevalent MI was 8.1% (95% CI: 4.4-14.2). The PPV of asymptomatic Q-wave to diagnose Q-wave UMI was 29.2% (95% CI: 18.2-43.2%) overall, but much higher (75%, 95% CI: 40.9-92.9%) in participants with 10-year CHD risk ≥10%, compared to lower-risk participants. CONCLUSION: Opportunistic identification of asymptomatic Q-waves by routine electrocardiogram overestimates actual Q-wave UMI, which represents 8% to 13% of all myocardial infarction in the population aged 35 to 74years. This overestimation is particularly high in the population at low cardiovascular risk. In epidemiological studies and in clinical practice, diagnosis of a pathologic Q-wave in asymptomatic patients requires detailed analysis of imaging tests to confirm or rule out myocardial necrosis.
BACKGROUND: Diagnosis of unrecognized myocardial infarction (UMI) remains an open question in epidemiological and clinical studies, inhibiting effective secondary prevention of myocardial infarction. We aimed to determine the prevalence and incidence of Q-wave UMI in asymptomatic individuals aged 35 to 74years, and to ascertain the positive predictive value (PPV) of asymptomatic Q-wave to diagnose UMI. METHODS: Two population-based cross-sectional studies were conducted, in 2000 (with 10-year follow-up) and in 2005. A baseline electrocardiogram was obtained for each participant. Imaging techniques (echocardiography, cardiac magnetic resonance imaging, and myocardial perfusion single-photon emission computerized tomography) were used to confirm UMI in patients with asymptomatic Q-wave. RESULTS: The prevalence of confirmed Q-wave UMI in the 5580 participants was 0.18% (95% confidence interval [CI]: 0.10-0.33) and the incidence rate was 27.1 Q-wave UMI per 100,000person-years. The proportion of confirmed Q-wave UMI with respect to all prevalent MI was 8.1% (95% CI: 4.4-14.2). The PPV of asymptomatic Q-wave to diagnose Q-wave UMI was 29.2% (95% CI: 18.2-43.2%) overall, but much higher (75%, 95% CI: 40.9-92.9%) in participants with 10-year CHD risk ≥10%, compared to lower-risk participants. CONCLUSION: Opportunistic identification of asymptomatic Q-waves by routine electrocardiogram overestimates actual Q-wave UMI, which represents 8% to 13% of all myocardial infarction in the population aged 35 to 74years. This overestimation is particularly high in the population at low cardiovascular risk. In epidemiological studies and in clinical practice, diagnosis of a pathologic Q-wave in asymptomatic patients requires detailed analysis of imaging tests to confirm or rule out myocardial necrosis.
Authors: Christoph B Olivier; Hillary Mulder; William R Hiatt; W Schuyler Jones; F Gerry R Fowkes; Frank W Rockhold; Jeffrey S Berger; Iris Baumgartner; Peter Held; Brian G Katona; Lars Norgren; Juuso Blomster; Manesh R Patel; Kenneth W Mahaffey Journal: JAMA Cardiol Date: 2019-01-01 Impact factor: 14.676
Authors: Anna M Nordenskjöld; Per Hammar; Håkan Ahlström; Tomas Bjerner; Olov Duvernoy; Bertil Lindahl Journal: PLoS One Date: 2018-07-06 Impact factor: 3.240