STOCKHOLM — A high proportion of MIs occurring in patients after age 55 go clinically unrecognized, Anneke de Torbal, M.D., reported at the annual congress of the European Society of Cardiology.
This observation from the prospective, population-based Rotterdam Study raises the possibility that periodic screening ECGs ought to be routine in older adults. It would result in identification of patients with previously unrecognized MI so they could have the benefit of placement on an intensive secondary prevention regimen, added Dr. de Torbal of Erasmus Medical Center, Rotterdam, the Netherlands.
The Rotterdam Study includes 4,187 men and women above age 55 who are free of evidence of prevalent MI by 12-lead ECG at baseline and who had a follow-up ECG a mean of 6.4 years later.
During the follow-up period, 141 subjects experienced a clinically recognized MI. This translated into an incidence of 5.0 cases/1,000 patient-years. The rate in men—8.4 cases/1,000 patient-years—was significantly greater than the 3.1/1,000 patient-years in women.
The incidence of clinically unrecognized MI picked up only by the screening ECGs performed as part of the Rotterdam Study protocol was 4.2 cases/1,000 patient-years in men and 3.6/1,000 patient-years in women. The investigators determined that the proportion of all MIs that were unrecognized was 54% in women, compared with 33% in men.