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European Heart Journal Advance Access published online on February 14, 2006
European Heart Journal, doi:10.1093/eurheartj/ehi707
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European Heart Journal © The European Society of Cardiology 2006; all rights reserved
Received April 12, 2005
Revised October 31, 2005
Accepted December 8, 2005

Clinical research

Incidence of recognized and unrecognized myocardial infarction in men and women aged 55 and older: the Rotterdam Study

Anneke de Torbal 1, Eric Boersma 1, Jan A. Kors 1, Gerard van Herpen 1, Jaap W. Deckers 1, Deirdre A.M. van der Kuip 1, Bruno H. Stricker 1, Albert Hofman 1, and Jacqueline C.M. Witteman 1 *

1 Department of Epidemiology and Biostatistics, Erasmus MC, PO Box 1738, 3000 DR Rotterdam, The Netherlands

* To whom correspondence should be addressed.
Jacqueline C.M. Witteman, E-mail: j.witteman{at}erasmusmc.nl


  Abstract

Aims Contemporary data on the incidence of unrecognized myocardial infarction (MI) among subjects aged 55 and older are limited.

Methods and results We studied the incidence of recognized and unrecognized MI in the Rotterdam Study, a population-based cohort of men and women aged 55 and older. The baseline examination was performed during 1990-93, with follow-up examinations during 1994-95, and 1997-2000. Baseline and follow-up 12-lead ECGs were analysed by the Modular ECG Analysis System. The 5148 participants who had no evidence of prevalent infarction were the subjects for analysis. Incident recognized infarction was defined as the occurrence of a fatal or non-fatal event coded as I21 according to the International Classification of Diseases, 10th edition. A repeat ECG was available in 4187 subjects. An unrecognized infarction was considered to have occurred if there was electrocardiographic evidence in the absence of a clinically recognized event. During a median follow-up of 6.4 years, 141 incident recognized infarctions occurred and the incidence rate of this event was 5.0 per 1000 person years. The incidence was higher in men (8.4) than in women (3.1). The incidence rate of unrecognized infarction was 3.8 per 1000 person years. Men (4.2) and women (3.6) had approximately similar incidence. Hence, the proportion of unrecognized infarction was lower in men (33%) than in women (54%). This difference in proportion of unrecognized infarctions was independent of age.

Conclusion A high proportion of incident MIs remains clinically unrecognized. As a history of MI is associated with an increased risk of repeat cardiovascular complications, our data suggest a need for periodical electrocardiographic screening to recognize (prevalent) infarctions and to install effective preventive treatment in those aged 55 and older.

Keywords: Myocardial infarction; Electrocardiogram; Elderly; Incidence.
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