Clinical Scorecard: Prognostic Outcomes of Undiagnosed Myocardial Infarction in Men and Women: Insights from the Rotterdam Study
At a Glance
Category
Detail
Condition
Unrecognized myocardial infarction (UMI)
Key Mechanisms
UMI detected by ECG without clinical history; associated with adverse cardiovascular outcomes including heart failure, atrial fibrillation, stroke, and mortality
Target Population
Middle-aged and older adults (mean age 64.8 years) from a population-based cohort
Care Setting
Primary and secondary cardiovascular care with ECG screening and medical record review
Key Highlights
UMI is associated with increased risks of heart failure, atrial fibrillation, stroke, and all-cause mortality in both sexes, with sex-specific differences in risk magnitude.
In women, UMI increases risk of heart failure and mortality, but associations attenuate after adjusting for cardiovascular risk factors; in men, UMI significantly increases risks of all adverse outcomes.
Cardiovascular risk factors contribute differently by sex, underscoring the need for sex-specific cardiovascular risk assessment and prevention strategies.
Guideline-Based Recommendations
Diagnosis
Use 12-lead ECG with Minnesota coding criteria to detect unrecognized MI in asymptomatic individuals.
Confirm ECG findings with clinical history and medical records to differentiate recognized from unrecognized MI.
Management
Implement sex-specific cardiovascular risk assessment and prevention for patients with UMI.
Address modifiable cardiovascular risk factors to mitigate adverse outcomes associated with UMI.
Monitoring & Follow-up
Long-term follow-up for heart failure, atrial fibrillation, stroke, and mortality in patients identified with UMI.
Regular cardiovascular risk factor evaluation and management tailored by sex.
Risks
UMI carries a substantial risk of adverse cardiovascular events and mortality comparable to recognized MI.
Sex differences influence the prognosis and risk factor impact in UMI patients.
Patient & Prescribing Data
Adults aged 45 years and older with unrecognized myocardial infarction detected by ECG in a population-based cohort.
Recognition of UMI should prompt cardiovascular risk factor modification and monitoring to reduce risks of heart failure, atrial fibrillation, stroke, and death, with attention to sex-specific risk profiles.
Clinical Best Practices
Screen at-risk populations with ECG to identify unrecognized myocardial infarction.
Incorporate sex-specific risk stratification in cardiovascular disease prevention and management.
Educate patients on atypical MI symptoms and encourage timely healthcare seeking to reduce underdiagnosis.
Manage traditional cardiovascular risk factors aggressively in patients with UMI to improve prognosis.
