南方医科大学黄裕立团队取得新进展。他们对心电图或心脏磁共振成像确诊的未识别心肌梗死的预后进行了系统回顾和荟萃分析。相关论文于2020年5月7日发表在《英国医学杂志》上。

为了评估心电图(UMI-ECG)和心脏磁共振成像(UMI-CMR)确诊的未识别心肌梗死的预后，研究组进行了一项前瞻性研究的系统评价和荟萃分析。他们从PubMed、Embase和Google Scholar等电子数据库中进行检索，筛选出比较未识别心肌梗死参与者与无心肌梗死参与者的前瞻性队列研究。

该荟萃分析共包括30项研究，涉及253425名参与者和1621920人年的随访。与无心肌梗死的参与者相比，UMI-ECG参与者的全因死亡、心血管死亡和主要不良心脏事件的风险增加。UMI-CMR参与者也与全因死亡、心血管死亡和主要不良心脏事件的风险增加相关。

在可识别心肌梗死和UMI-ECG或UMI-CMR之间，没有观察到任何主要异质性。与无心肌梗死的参与者相比，UMI-ECG参与者全因死亡的绝对危险度为每1000人年7.50，心血管死亡为11.04，主要不良心脏事件为27.45;UMI-CMR参与者则分别为32.49、37.2和51.96。

总之，UMI-ECG或UMI-CMR与不良长期预后相关，与可识别的心肌梗死相似。

附:英文原文

Title: Prognosis of unrecognised myocardial infarction determined by electrocardiography or cardiac magnetic resonance imaging: systematic review and meta-analysis

Author: Yu Yang, Wensheng Li, Hailan Zhu, Xiong-Fei Pan, Yunzhao Hu, Clare Arnott, Weiyi Mai, Xiaoyan Cai, Yuli Huang

Issue&Volume: 2020/05/07

Abstract: Objective To evaluate the prognosis of unrecognised myocardial infarction determined by electrocardiography (UMI-ECG) or cardiac magnetic resonance imaging (UMI-CMR).

Design Systematic review and meta-analysis of prospective studies.

Data sources Electronic databases, including PubMed, Embase, and Google Scholar.

Study selection Prospective cohort studies were included if they reported adjusted relative risks, odds ratios, or hazard ratios and 95% confidence intervals for all cause mortality or cardiovascular outcomes in participants with unrecognised myocardial infarction compared with those without myocardial infarction.

Data extraction and synthesis The primary outcomes were composite major adverse cardiac events, all cause mortality, and cardiovascular mortality associated with UMI-ECG and UMI-CMR. The secondary outcomes were the risks of recurrent coronary heart disease or myocardial infarction, stroke, heart failure, and atrial fibrillation. Pooled hazard ratios and 95% confidence intervals were reported. The heterogeneity of outcomes was compared in clinically recognised and unrecognised myocardial infarction.

Results The meta-analysis included 30 studies with 253425 participants and 1621920 person years of follow-up. UMI-ECG was associated with increased risks of all cause mortality (hazard ratio 1.50, 95% confidence interval 1.30 to 1.73), cardiovascular mortality (2.33, 1.66 to 3.27), and major adverse cardiac events (1.61, 1.38 to 1.89) compared with the absence of myocardial infarction. UMI-CMR was also associated with increased risks of all cause mortality (3.21, 1.43 to 7.23), cardiovascular mortality (10.79, 4.09 to 28.42), and major adverse cardiac events (3.23, 2.10 to 4.95). No major heterogeneity was observed for any primary outcomes between recognised myocardial infarction and UMI-ECG or UMI-CMR. The absolute risk differences were 7.50 (95% confidence interval 4.50 to 10.95) per 1000 person years for all cause mortality, 11.04 (5.48 to 18.84) for cardiovascular mortality, and 27.45 (17.1 to 40.05) for major adverse cardiac events in participants with UMI-ECG compared with those without myocardial infarction. The corresponding data for UMI-CMR were 32.49 (6.32 to 91.58), 37.2 (11.7 to 104.20), and 51.96 (25.63 to 92.04), respectively.

Conclusions UMI-ECG or UMI-CMR is associated with an adverse long term prognosis similar to that of recognised myocardial infarction. Screening for unrecognised myocardial infarction could be useful for risk stratification among patients with a high risk of cardiovascular disease.

DOI: 10.1136/bmj.m1184

Source: https://www.bmj.com/content/369/bmj.m1184

文章来源：《心电图杂志(电子版)》 网址: http://www.xdtzzzz.cn/zonghexinwen/2020/0521/359.html