Association of Silent Myocardial Infarction and Sudden Cardiac Death

Juha H. Vähätalo, Heikki V. Huikuri, Lauri T.A. Holmström, Tuomas V. Kenttä, M. Anette E. Haukilahti, Lasse Pakanen, Kari S. Kaikkonen, Jani Tikkanen, Juha S. Perkiömäki, Robert J. Myerburg, M. Juhani Junttila

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Importance: Myocardial infarction in the absence of major or unrecognized symptoms are characterized as silent (SMI). The prevalence of SMI among individuals who experience sudden cardiac death (SCD), with or without concomitant electrocardiographic (ECG) changes, has not previously been described in detail from large studies to our knowledge. Objective: To determine the prevalence of SMI in individuals who experience SCD without a prior diagnosis of coronary artery disease (CAD) and to detect ECG abnormalities associated with SMI-associated SCD. Design, Setting, and Participants: This case-control study compared autopsy findings, clinical characteristics, and ECG markers associated with SMI in a consecutive cohort of individuals in the Finnish Genetic Study of Arrhythmic Events (Fingesture) study population who were verified to have had SCD. The Fingesture study consists of individuals who had autopsy-verified SCD in Northern Finland between 1998 and 2017. Individuals who had SCD with CAD and evidence of SMI were regarded as having had cases; those who had SCD with CAD without SMI were considered control participants. Analyses of ECG tests were carried out by investigators blinded to the SMI data. Data analysis was completed from October 2018 through November 2018. Main Outcomes and Measures: Silent MI was defined as a scar detected by macroscopic and microscopic evaluation of myocardium without previously diagnosed CAD. Clinical history was obtained from medical records, previously recorded ECGs, and a standardized questionnaire provided to the next of kin. The hypothesis tested was that SMI would be prevalent in the population who had had SCD with CAD, and it might be detected or suspected from findings on ECGs prior to death in many individuals. Results: A total of 5869 individuals were included (2459 males [78.8%]; mean [SD] age, 64.9 [12.4] years). The cause of SCD was CAD in 4392 individuals (74.8%), among whom 3122 had no history of previously diagnosed CAD. Two individuals were excluded owing to incomplete autopsy information. An ECG recorded prior to SCD was available in 438 individuals. Silent MI was detected in 1322 individuals (42.4%) who experienced SCD without a clinical history of CAD. The participants with SMI were older than participants without MI scarring (mean [SD] age, 66.9 [11.1] years; 65.5 [11.6] years; P <.001) and were more often men (1102 of 1322 [83.4%] vs 1357 of 1798 [75.5%]; P <.001). Heart weight was higher in participants with SMI (mean [SD] weight, 483 [109] g vs 438 [106] g; P <.001). In participants with SMI, SCD occurred more often during physical activity (241 of 1322 [18.2%] vs 223 of 1798 [12.4%]; P <.001). A prior ECG was abnormal in 125 of the 187 individuals (66.8%) who had SCD after SMI compared with 139 of 251 (55.4%) of those who had SCD without SMI (P =.02). Conclusions and Relevance: Many individuals who experienced SCD associated with CAD had a previously undetected MI at autopsy. Previous SMI was associated with myocardial hypertrophy and SCD during physical activity. Premortem ECGs in a subset with available data were abnormal in 67% of the individuals who had had a SCD after an SMI.

Original languageEnglish (US)
JournalJAMA cardiology
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

Fingerprint

Sudden Cardiac Death
Myocardial Infarction
Coronary Artery Disease
Autopsy
Electrocardiography
Cicatrix
Exercise
Weights and Measures
Finland

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Vähätalo, J. H., Huikuri, H. V., Holmström, L. T. A., Kenttä, T. V., Haukilahti, M. A. E., Pakanen, L., ... Junttila, M. J. (2019). Association of Silent Myocardial Infarction and Sudden Cardiac Death. JAMA cardiology. https://doi.org/10.1001/jamacardio.2019.2210

Association of Silent Myocardial Infarction and Sudden Cardiac Death. / Vähätalo, Juha H.; Huikuri, Heikki V.; Holmström, Lauri T.A.; Kenttä, Tuomas V.; Haukilahti, M. Anette E.; Pakanen, Lasse; Kaikkonen, Kari S.; Tikkanen, Jani; Perkiömäki, Juha S.; Myerburg, Robert J.; Junttila, M. Juhani.

In: JAMA cardiology, 01.01.2019.

Research output: Contribution to journalArticle

Vähätalo, JH, Huikuri, HV, Holmström, LTA, Kenttä, TV, Haukilahti, MAE, Pakanen, L, Kaikkonen, KS, Tikkanen, J, Perkiömäki, JS, Myerburg, RJ & Junttila, MJ 2019, 'Association of Silent Myocardial Infarction and Sudden Cardiac Death', JAMA cardiology. https://doi.org/10.1001/jamacardio.2019.2210
Vähätalo JH, Huikuri HV, Holmström LTA, Kenttä TV, Haukilahti MAE, Pakanen L et al. Association of Silent Myocardial Infarction and Sudden Cardiac Death. JAMA cardiology. 2019 Jan 1. https://doi.org/10.1001/jamacardio.2019.2210
Vähätalo, Juha H. ; Huikuri, Heikki V. ; Holmström, Lauri T.A. ; Kenttä, Tuomas V. ; Haukilahti, M. Anette E. ; Pakanen, Lasse ; Kaikkonen, Kari S. ; Tikkanen, Jani ; Perkiömäki, Juha S. ; Myerburg, Robert J. ; Junttila, M. Juhani. / Association of Silent Myocardial Infarction and Sudden Cardiac Death. In: JAMA cardiology. 2019.
@article{42a3627da2374314b7a6823806f66ec7,
title = "Association of Silent Myocardial Infarction and Sudden Cardiac Death",
abstract = "Importance: Myocardial infarction in the absence of major or unrecognized symptoms are characterized as silent (SMI). The prevalence of SMI among individuals who experience sudden cardiac death (SCD), with or without concomitant electrocardiographic (ECG) changes, has not previously been described in detail from large studies to our knowledge. Objective: To determine the prevalence of SMI in individuals who experience SCD without a prior diagnosis of coronary artery disease (CAD) and to detect ECG abnormalities associated with SMI-associated SCD. Design, Setting, and Participants: This case-control study compared autopsy findings, clinical characteristics, and ECG markers associated with SMI in a consecutive cohort of individuals in the Finnish Genetic Study of Arrhythmic Events (Fingesture) study population who were verified to have had SCD. The Fingesture study consists of individuals who had autopsy-verified SCD in Northern Finland between 1998 and 2017. Individuals who had SCD with CAD and evidence of SMI were regarded as having had cases; those who had SCD with CAD without SMI were considered control participants. Analyses of ECG tests were carried out by investigators blinded to the SMI data. Data analysis was completed from October 2018 through November 2018. Main Outcomes and Measures: Silent MI was defined as a scar detected by macroscopic and microscopic evaluation of myocardium without previously diagnosed CAD. Clinical history was obtained from medical records, previously recorded ECGs, and a standardized questionnaire provided to the next of kin. The hypothesis tested was that SMI would be prevalent in the population who had had SCD with CAD, and it might be detected or suspected from findings on ECGs prior to death in many individuals. Results: A total of 5869 individuals were included (2459 males [78.8{\%}]; mean [SD] age, 64.9 [12.4] years). The cause of SCD was CAD in 4392 individuals (74.8{\%}), among whom 3122 had no history of previously diagnosed CAD. Two individuals were excluded owing to incomplete autopsy information. An ECG recorded prior to SCD was available in 438 individuals. Silent MI was detected in 1322 individuals (42.4{\%}) who experienced SCD without a clinical history of CAD. The participants with SMI were older than participants without MI scarring (mean [SD] age, 66.9 [11.1] years; 65.5 [11.6] years; P <.001) and were more often men (1102 of 1322 [83.4{\%}] vs 1357 of 1798 [75.5{\%}]; P <.001). Heart weight was higher in participants with SMI (mean [SD] weight, 483 [109] g vs 438 [106] g; P <.001). In participants with SMI, SCD occurred more often during physical activity (241 of 1322 [18.2{\%}] vs 223 of 1798 [12.4{\%}]; P <.001). A prior ECG was abnormal in 125 of the 187 individuals (66.8{\%}) who had SCD after SMI compared with 139 of 251 (55.4{\%}) of those who had SCD without SMI (P =.02). Conclusions and Relevance: Many individuals who experienced SCD associated with CAD had a previously undetected MI at autopsy. Previous SMI was associated with myocardial hypertrophy and SCD during physical activity. Premortem ECGs in a subset with available data were abnormal in 67{\%} of the individuals who had had a SCD after an SMI.",
author = "V{\"a}h{\"a}talo, {Juha H.} and Huikuri, {Heikki V.} and Holmstr{\"o}m, {Lauri T.A.} and Kentt{\"a}, {Tuomas V.} and Haukilahti, {M. Anette E.} and Lasse Pakanen and Kaikkonen, {Kari S.} and Jani Tikkanen and Perki{\"o}m{\"a}ki, {Juha S.} and Myerburg, {Robert J.} and Junttila, {M. Juhani}",
year = "2019",
month = "1",
day = "1",
doi = "10.1001/jamacardio.2019.2210",
language = "English (US)",
journal = "JAMA Cardiology",
issn = "2380-6583",
publisher = "American Medical Association",

}

TY - JOUR

T1 - Association of Silent Myocardial Infarction and Sudden Cardiac Death

AU - Vähätalo, Juha H.

AU - Huikuri, Heikki V.

AU - Holmström, Lauri T.A.

AU - Kenttä, Tuomas V.

AU - Haukilahti, M. Anette E.

AU - Pakanen, Lasse

AU - Kaikkonen, Kari S.

AU - Tikkanen, Jani

AU - Perkiömäki, Juha S.

AU - Myerburg, Robert J.

AU - Junttila, M. Juhani

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Importance: Myocardial infarction in the absence of major or unrecognized symptoms are characterized as silent (SMI). The prevalence of SMI among individuals who experience sudden cardiac death (SCD), with or without concomitant electrocardiographic (ECG) changes, has not previously been described in detail from large studies to our knowledge. Objective: To determine the prevalence of SMI in individuals who experience SCD without a prior diagnosis of coronary artery disease (CAD) and to detect ECG abnormalities associated with SMI-associated SCD. Design, Setting, and Participants: This case-control study compared autopsy findings, clinical characteristics, and ECG markers associated with SMI in a consecutive cohort of individuals in the Finnish Genetic Study of Arrhythmic Events (Fingesture) study population who were verified to have had SCD. The Fingesture study consists of individuals who had autopsy-verified SCD in Northern Finland between 1998 and 2017. Individuals who had SCD with CAD and evidence of SMI were regarded as having had cases; those who had SCD with CAD without SMI were considered control participants. Analyses of ECG tests were carried out by investigators blinded to the SMI data. Data analysis was completed from October 2018 through November 2018. Main Outcomes and Measures: Silent MI was defined as a scar detected by macroscopic and microscopic evaluation of myocardium without previously diagnosed CAD. Clinical history was obtained from medical records, previously recorded ECGs, and a standardized questionnaire provided to the next of kin. The hypothesis tested was that SMI would be prevalent in the population who had had SCD with CAD, and it might be detected or suspected from findings on ECGs prior to death in many individuals. Results: A total of 5869 individuals were included (2459 males [78.8%]; mean [SD] age, 64.9 [12.4] years). The cause of SCD was CAD in 4392 individuals (74.8%), among whom 3122 had no history of previously diagnosed CAD. Two individuals were excluded owing to incomplete autopsy information. An ECG recorded prior to SCD was available in 438 individuals. Silent MI was detected in 1322 individuals (42.4%) who experienced SCD without a clinical history of CAD. The participants with SMI were older than participants without MI scarring (mean [SD] age, 66.9 [11.1] years; 65.5 [11.6] years; P <.001) and were more often men (1102 of 1322 [83.4%] vs 1357 of 1798 [75.5%]; P <.001). Heart weight was higher in participants with SMI (mean [SD] weight, 483 [109] g vs 438 [106] g; P <.001). In participants with SMI, SCD occurred more often during physical activity (241 of 1322 [18.2%] vs 223 of 1798 [12.4%]; P <.001). A prior ECG was abnormal in 125 of the 187 individuals (66.8%) who had SCD after SMI compared with 139 of 251 (55.4%) of those who had SCD without SMI (P =.02). Conclusions and Relevance: Many individuals who experienced SCD associated with CAD had a previously undetected MI at autopsy. Previous SMI was associated with myocardial hypertrophy and SCD during physical activity. Premortem ECGs in a subset with available data were abnormal in 67% of the individuals who had had a SCD after an SMI.

AB - Importance: Myocardial infarction in the absence of major or unrecognized symptoms are characterized as silent (SMI). The prevalence of SMI among individuals who experience sudden cardiac death (SCD), with or without concomitant electrocardiographic (ECG) changes, has not previously been described in detail from large studies to our knowledge. Objective: To determine the prevalence of SMI in individuals who experience SCD without a prior diagnosis of coronary artery disease (CAD) and to detect ECG abnormalities associated with SMI-associated SCD. Design, Setting, and Participants: This case-control study compared autopsy findings, clinical characteristics, and ECG markers associated with SMI in a consecutive cohort of individuals in the Finnish Genetic Study of Arrhythmic Events (Fingesture) study population who were verified to have had SCD. The Fingesture study consists of individuals who had autopsy-verified SCD in Northern Finland between 1998 and 2017. Individuals who had SCD with CAD and evidence of SMI were regarded as having had cases; those who had SCD with CAD without SMI were considered control participants. Analyses of ECG tests were carried out by investigators blinded to the SMI data. Data analysis was completed from October 2018 through November 2018. Main Outcomes and Measures: Silent MI was defined as a scar detected by macroscopic and microscopic evaluation of myocardium without previously diagnosed CAD. Clinical history was obtained from medical records, previously recorded ECGs, and a standardized questionnaire provided to the next of kin. The hypothesis tested was that SMI would be prevalent in the population who had had SCD with CAD, and it might be detected or suspected from findings on ECGs prior to death in many individuals. Results: A total of 5869 individuals were included (2459 males [78.8%]; mean [SD] age, 64.9 [12.4] years). The cause of SCD was CAD in 4392 individuals (74.8%), among whom 3122 had no history of previously diagnosed CAD. Two individuals were excluded owing to incomplete autopsy information. An ECG recorded prior to SCD was available in 438 individuals. Silent MI was detected in 1322 individuals (42.4%) who experienced SCD without a clinical history of CAD. The participants with SMI were older than participants without MI scarring (mean [SD] age, 66.9 [11.1] years; 65.5 [11.6] years; P <.001) and were more often men (1102 of 1322 [83.4%] vs 1357 of 1798 [75.5%]; P <.001). Heart weight was higher in participants with SMI (mean [SD] weight, 483 [109] g vs 438 [106] g; P <.001). In participants with SMI, SCD occurred more often during physical activity (241 of 1322 [18.2%] vs 223 of 1798 [12.4%]; P <.001). A prior ECG was abnormal in 125 of the 187 individuals (66.8%) who had SCD after SMI compared with 139 of 251 (55.4%) of those who had SCD without SMI (P =.02). Conclusions and Relevance: Many individuals who experienced SCD associated with CAD had a previously undetected MI at autopsy. Previous SMI was associated with myocardial hypertrophy and SCD during physical activity. Premortem ECGs in a subset with available data were abnormal in 67% of the individuals who had had a SCD after an SMI.

UR - http://www.scopus.com/inward/record.url?scp=85068936119&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85068936119&partnerID=8YFLogxK

U2 - 10.1001/jamacardio.2019.2210

DO - 10.1001/jamacardio.2019.2210

M3 - Article

C2 - 31290935

AN - SCOPUS:85068936119

JO - JAMA Cardiology

JF - JAMA Cardiology

SN - 2380-6583

ER -