Silent MI Before Acute Heart Attack Can Be Poor Prognostic Indicator Interview with:

Robin Nijveldt  MD PhD FESC Radboudumc Department of Cardiology The Netherlands

Dr. Nijveldt

Robin Nijveldt  MD PhD FESC
Radboudumc, Department of Cardiology and
VU University Medical Center
Department of cardiology
the Netherlands What is the background for this study? What are the main findings?

Response: We know from previous studies that patients with unrecognized myocardial infarcts have worse prognosis than people without infarcts.

It was currently unknown in how many patients presenting with a first acute myocardial infarction had previous unrecognized MI, and if so, if this is still a prognostic marker on long term follow-up.

In this paper we studied 405 patients from 2 academic hospitals in the Netherlands, with an average follow-up duration of 6.8 years. We found that silent MI was present in 8.2% of patients presenting with first acute MI, and that silent MI is a strong and independent predictor for adverse long-term clinical outcome such as death (HR 3.69) or the composite end point of death, reinfarction, ischemic stroke, or CABG (HR 3.05). Additionally, it appears that ECG is of limited value to detect silent MI, since our study did not reveal an association with long-term clinical outcome. What should readers take away from your report?

Response: Patients after first acute MI with previous silent MI represent a group of patients with a more than 3-fold risk of mortality and MACE. It is important to realize for clinicians to recognize these patients as a high risk patient group, and therefore closer monitoring during follow-up. Also, it is important to realize that silent MI is an important confounder in research aiming to improve outcome after acute MI by new therapeutic strategies or medical treatment. What recommendations do you have for future research as a result of this work?

Response: It would be very interesting to unravel the pathophysiological background, for example by serial CMR assessment of acute MI patients with silent MI in comparison to first acute MI patients without silent MI. Additionally it is important to investigate whether there is a relation between plaque burden and extent, and the presence of silent MI and hence worse outcome, for example by evaluating the coronary arteries by OCT, and to see if more aggressive statin treatment will improve outcome in this high risk patient group.  


Long-Term Prognostic Implications of Previous Silent Myocardial Infarction in Patients Presenting With Acute Myocardial Infarction

Raquel P. Amier, Martijn W. Smulders, Wiesje M. van der Flier, Sebastiaan C.A.M. Bekkers, Alwin Zweerink, Cornelis P. Allaart, Ahmet Demirkiran, Sebastiaan T. Roos, Paul F.A. Teunissen, Yolande Appelman, Niels van Royen, Raymond J. Kim, Albert C. van Rossum, Robin Nijveldt

JACC: Cardiovascular Imaging Apr 2018, 2570; DOI:10.1016/j.jcmg.2018.02.009

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