Burgess et al reported predictors of silent acute myocardial infarction in a patient with type 2 diabetes mellitus. These factors are also predictive of overt AMI. The authors are from multiple institutions in Australia and Finland.
Patient selection: type 2 diabetes mellitus
Criteria for a silent myocardial infarction:
(1) appearance of Q waves (easier to recognize with serial ECGs over time)
(2) no history of symptoms consistent with myocardial infarction
Predictors with odds ratio >= 1.5 and low p value in multivariate analysis:
(1) duration of diabetes in years (OR 0.97, requires many years)
(2) history of prior cardiovascular disease (OR 1.62)
(3) macroalbuminuria (OR 2.51; using albumin to creatinine ratio)
(4) older age (OR 1.03 per year; may overlap with duration of diabetes)
Other factors associated with silent AMI:
(1) male sex
(2) diabetic neuropathy
(3) higher hemoglobin A1c
(4) microalbuminuria
(5) high serum creatinine concentration
(6) insulin use
Protective factors:
(1) fenofibrate therapy
The occurrence of unrecognized myocardial ischemia is associated with a worse prognosis.
