Unrecognized myocardial infarction

This review addresses myocardial infarctions that escape clinical recogniti on. It focuses on the prevalence, predisposing factors, and prognosis of th ese unrecognized infarctions, and incorporates data from relevant epidemiol ogic studies, basic science investigations, and review articles. These data indicate that at least one fourth of all myocardial infarctions are clinic ally unrecognized. The demographic characteristics and coronary risk factor profiles of persons with previously unrecognized myocardial infarctions ap pear to be similar to those of persons whose infarctions are clinically det ected. Impaired symptom perception may contribute to lack of recognition, b ut both patients' and physicians' perceptions about the risk for myocardial infarction may also play an important role. Finally, mortality rates after unrecognized and recognized myocardial infarction are similar. Given the p ublic health implications of unrecognized myocardial infarction, future stu dies should address screening strategies, risk stratification after detecti on of previously unrecognized myocardial infarction, and the role of standa rd postinfarction therapies in affected patients.