Unrecognised myocardial infarction before elective PCI: a review

There is little research into the prevalence of unrecognised myocardial infarction in patients who are undergoing percutaneous coronary intervention. Little is also known about the significance of unrecognised myocardial infarction in regard to percutaneous coronary intervention. In this study, it was found that 29.6% of 236 patients undergoing percutaneous coronary intervention had unrecognised myocardial infarction. These were all patients with no known history of myocardial infarction and no previous revascularisation. This result is significant because unrecognised myocardial infarction correlates with adverse outcomes – specifically major adverse cardiac effects after successful percutaneous coronary intervention. These effects include cardiovascular death and hospitalisation for congestive heart failure. This is thought to be related to the advanced atherosclerotic burden that is related to unrecognised myocardial infarction.

This review by Nogami K et al. aimed to research the prevalence and prognostic impact of unrecognised myocardial infarction on patients undergoing percutaneous coronary intervention.

Key learnings

Although it is acknowledged that unrecognised myocardial infarction relates to poor prognosis, further research is needed to fully understand the mechanisms behind for the relationship between the two. Understanding this may allow for unrecognised myocardial infarction to be evaluated when deciding between an invasive approach or guideline-directed pharmacotherapy alone in for clinical trials. In the end, specific treatments for improving prognosis for these patients after percutaneous coronary intervention remains unavailable.