Long-term prognosis of unrecognized myocardial infarction in women and men from the general population: the Rotterdam Study

Abstract Aims Unrecognized myocardial infarction (UMI) is associated with an adverse prognosis, but sex-specific differences in outcomes are not fully understood. Methods and results We included 12 303 participants (57.6% women, mean age 64.8 years) from the Rotterdam Study. Baseline myocardial infarction (MI) status (1990–2008) was determined by electrocardiogram and medical records, categorizing participants as UMI (n = 512), recognized MI (RMI) (n = 669), or no MI (n = 11 122). Outcomes included heart failure (HF), atrial fibrillation (AF), stroke, and all-cause mortality. In women, compared with no MI, UMI was associated with larger risks of HF [hazard ratio (HR) 1.31, 95% confidence interval (CI) 1.01–1.71] and all-cause mortality (HR 1.21, 95% CI 1.05–1.40), but lost significance after adjusting for cardiovascular risk factors. Unrecognized MI was non-significantly associated with a larger risk of stroke (HR 1.27, 95% CI 0.95–1.70), but not AF (HR 0.96, 95% CI 0.70–1.33). Recognized MI in women significantly increased risks of HF (HR 2.58, 95% CI 1.94–3.43), AF (HR 1.62, 95% CI 1.13–2.32), and all-cause mortality (HR 1.81, 95% CI 1.54–2.12), but not stroke (HR 1.41, 95% CI 0.98–2.04). Among men, both UMI and RMI were associated with larger risks of HF (UMI: HR 1.90, 95% CI 1.45–2.48, RMI: HR 2.49, 95% CI 2.09–2.98), AF (UMI: HR 1.91, 95% CI 1.45–2.54, RMI: HR 1.79, 95% CI 1.46–2.19), stroke (UMI: HR 2.06, 95% CI 1.52–2.80, RMI: HR 1.36, 95% CI 1.06–1.76), and all-cause mortality (UMI: HR 1.59, 95% CI 1.36–1.85, RMI: HR 1.63, 95% CI 1.46–1.81). Conclusion Unrecognized myocardial infarction has a differential impact on the long-term prognosis in women and men, highlighting the need to identify key predictors of adverse outcomes.