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Prevalence and Prognosis of Unrecognized Myocardial Infarction Determined by Cardiac Magnetic Resonance in Older Adults
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  • Description:

    Unrecognized myocardial infarction (MI) is prognostically important but electrocardiography (ECG), the main epidemiology tool for detection, is insensitive to MI.


    Determine prevalence and mortality risk for unrecognized MI (UMI) detected by cardiac magnetic resonance (CMR) or ECG.


    ICELAND MI is a cohort substudy of the Age, Gene/Environment Susceptibility-Reykjavik Study (enrollment January 2004–January 2007) using ECG or CMR to detect UMI.


    Community dwelling participants in Iceland over age 67.


    936 participants (ages 67–93 years) including 670 who were randomly selected and 266 with diabetes.

    Main Outcome Measures

    MI prevalence and mortality through September 1, 2011. Results reported with 95% confidence limits and net reclassification improvement (NRI).


    Of 936 participants, 91 had recognized MI (RMI; 9.7% CI 8–12%), and 157 had UMI by CMR (17%; CI 14–19%) which was more prevalent than the 46 UMI by ECG (5%; CI 4–6%, p<0.001). Diabetic participants had more UMI by CMR than UMI by ECG (n=72; 21%; CI 17–26% vs. n=15; 4%; CI 2–7%, p<0.001). UMI by CMR was associated with atherosclerosis risk factors, coronary calcium, coronary revascularization, and peripheral vascular disease. Over a median of 6.4 years, 33% (CI 23–43%) of individuals with RMI died (30 of 91) and 28% (CI 21–35%) with UMI died (44 of 157), both higher rates than the 17% (CI 15–20%) with no MI that died (119 of 688). UMI by CMR improved risk stratification for mortality over RMI (NRI: 0.34; CI 0.16–0.53). Adjusting for age, sex, diabetes, and RMI, UMI by CMR remained associated with mortality (HR 1.45 CI 1.02–2.06, absolute risk increase (ARI) 8%) and significantly improved risk stratification for mortality, NRI 0.16 (CI 0.01–0.31)) but UMI by ECG did not (HR 0.88, CI 0.45–1.73 ARI −2%; NRI: −0.05; CI −0.17–0.05). Compared to those with RMI, participants with UMI by CMR used cardiac medications such as statins less often (36%; CI, 28–43% or 56/157 vs.73%; CI 63–82% or 66/91; p<0.001).


    In a community-based cohort, the prevalence of UMI by CMR was higher than the prevalence of recognized MI or UMI by ECG, and was associated with increased mortality risk.

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  • Funding:
    N01 AG012100/AG/NIA NIH HHS/United States
    N01-AG-12100/AG/NIA NIH HHS/United States
    Z01 AG007380-02/Intramural NIH HHS/United States
    Z01 AG007380-03/Intramural NIH HHS/United States
    Z01 HL004607-08 CE/CE/NCIPC CDC HHS/United States
    Z01 HL004607-09/Intramural NIH HHS/United States
    Z01 HL004607-10/Intramural NIH HHS/United States
    Z99 HL999999/Intramural NIH HHS/United States
    ZIA AG007380-04/Intramural NIH HHS/United States
    ZIA AG007380-05/Intramural NIH HHS/United States
    ZIA AG007380-06/Intramural NIH HHS/United States
    ZIA AG007380-07/Intramural NIH HHS/United States
    ZIA HL004607-11/Intramural NIH HHS/United States
    ZIA HL004607-12/Intramural NIH HHS/United States
    ZIA HL004607-14/Intramural NIH HHS/United States
    ZIA HL006136-01/Intramural NIH HHS/United States
    ZIA HL006136-02/Intramural NIH HHS/United States
    ZIE HL006139-01/Intramural NIH HHS/United States
    ZIE HL006139-02/Intramural NIH HHS/United States
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