Small and large vessel disease in persons with unrecognized compared to recognized myocardial infarction: The Tromsø Study 2007–2008

Journal article


Ohrn, Andrea M., Schirmer, Henrik, von Hanno, Therese, Mathiesen, Ellisiv B., Arntzen, Kjell A., Bertelsen, Geir, Njolstad, Inger, Loechen, Maja-Lisa, Wilsgaard, Tom, Merz, C. N. B. and Lindekleiv, H.. (2018). Small and large vessel disease in persons with unrecognized compared to recognized myocardial infarction: The Tromsø Study 2007–2008. International Journal of Cardiology. 253, pp. 14 - 19. https://doi.org/10.1016/j.ijcard.2017.10.009
AuthorsOhrn, Andrea M., Schirmer, Henrik, von Hanno, Therese, Mathiesen, Ellisiv B., Arntzen, Kjell A., Bertelsen, Geir, Njolstad, Inger, Loechen, Maja-Lisa, Wilsgaard, Tom, Merz, C. N. B. and Lindekleiv, H.
Abstract

Background: Unrecognized myocardial infarction (MI) is a frequent condition with unknown underlying reason. We hypothesized the lack of recognition of MI is related to pathophysiology, specifically differences in underlying small and large vessel disease. Methods: 6128 participants were examined with retinal photography, ultrasound of the carotid artery and a 12 lead electrocardiography (ECG). Small vessel disease was defined as narrower retinal arterioles and/or wider retinal venules measured on retinal photographs. Large vessel disease was defined as carotid artery pathology. We defined unrecognized MI as ECG-evidence of MI without a clinically recognized event. We analyzed the cross-sectional relationship between MI recognition and markers of small and large vessel disease, adjusted for age and sex. Results: Unrecognized MI was present in 502 (8.2%) and recognized MI in 326 (5.3%) of the 6128 participants. Compared to recognized MI, unrecognized MI was associated with small vessel disease indicated by narrower retinal arterioles (OR 1.66, 95% CI 1.05–2.62, highest vs. lowest quartile). Unrecognized MI was less associated with wider retinal venules (OR 0.55, 95% CI 0.35–0.87, lowest vs. highest quartile). Compared to recognized MI, unrecognized MI was less associated with large vessel disease indicated by presence of plaque in the carotid artery (OR for presence of carotid artery plaque in unrecognized MI 0.51, 95% CI 0.37–0.69). No significant sex interaction was present. Conclusions: Unrecognized MI was more associated with small vessel disease and less associated with large vessel disease compared to recognized MI. These findings suggest that the pathophysiology behind unrecognized and recognized MI may differ.

Year2018
JournalInternational Journal of Cardiology
Journal citation253, pp. 14 - 19
PublisherElsevier Ireland Ltd.
ISSN0167-5273
Digital Object Identifier (DOI)https://doi.org/10.1016/j.ijcard.2017.10.009
Scopus EID2-s2.0-85039948115
Page range14 - 19
Research GroupMary MacKillop Institute for Health Research
Publisher's version
File Access Level
Controlled
Place of publicationIreland
EditorsA. S. Coats
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